| Image M.d. | |
|
12805 Victory Blvd N Hollywood CA 91606-3012 | |
| (818) 506-5906 | |
| Not Available |
| Full Name | Image M.d. |
|---|---|
| Speciality | General Practice |
| Location | 12805 Victory Blvd, N Hollywood, California |
| Authorized Official Name and Position | Clarence Sutton (PHYSICIAN OWNER) |
| Authorized Official Contact | 8185065906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Image M.d. 12805 Victory Blvd N Hollywood CA 91606-3012 Ph: (818) 506-5906 | Image M.d. 12805 Victory Blvd N Hollywood CA 91606-3012 Ph: (818) 506-5906 |
| NPI Number | 1104978766 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104978766 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | G74582 (California) | Primary |
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