Organization
FUBOS IMAGING, INC.
Active
Other names
Imperial Diagnostic
Organization subpart
No
Provider details
NPI number
Authorized official
VIKTORIYA KONDRATYUK (PRESIDENT)
(310) 590-1547
Entity
Organization
Contact information
Practice address
11161 CRENSHAW BLVD, SUITE 120, INGLEWOOD, CA 90303-2336
(310) 590-1547
(310) 590-1546
Mailing address
11161 CRENSHAW BLVD, SUITE 120, INGLEWOOD, CA 90303-2336
(310) 590-1547
(310) 590-1546
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
05/26/2006
Last updated
08/22/2020
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