Organization
ATHLETIC IMAGING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW PAUL THIERRY MD (CEO)
(310) 740-6544
Entity
Organization
Contact information
Practice address
492 E CHANNEL RD, SANTA MONICA, CA 90402-1339
(310) 740-6544
Mailing address
492 E CHANNEL RD, SANTA MONICA, CA 90402-1339
(310) 740-6544
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A112782
MEDICAL LICENSE NUMBER
CA
Enumeration date
05/01/2018
Last updated
05/01/2018
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