| Organization Name: | IMAGE M.D. |
| NPI Number: | 1104978766 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLARENCE SUTTON (PHYSICIAN OWNER) |
| Mailing Address: | 12805 Victory Blvd N Hollywood |
| State: | CA US |
| Postal Code: | 916063012 |
| Phone Number: | 8185065906 |
| Fax Number: | |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G74582 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |