Provider Demographics
NPI:1174579932
Name:SPIROMETRIC INC
Entity type:Organization
Organization Name:SPIROMETRIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOLOTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-571-5702
Mailing Address - Street 1:16200 VENTURA BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2205
Mailing Address - Country:US
Mailing Address - Phone:818-981-4337
Mailing Address - Fax:818-981-4337
Practice Address - Street 1:16200 VENTURA BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2205
Practice Address - Country:US
Practice Address - Phone:818-981-4337
Practice Address - Fax:818-981-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG563Medicare ID - Type Unspecified