MEDICARE: BRAND DIAGNOSTIC CENTER,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1003865767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAND DIAGNOSTIC CENTER,INC

Provider Business Mailing Address
First Line	:	100 N BRAND BLVD
Second Line	:	SUITE 532
City	:	GLENDALE
State	:	CA
Zip	:	91203-2641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N BRAND BLVD
Second Line	:	SUITE 532
City	:	GLENDALE
State	:	CA
Zip	:	91203-2641
Country	:	US
Telephone Number	:	818-476-0075
Fax Number	:	818-476-0081

Authorized Official
Title or Position	:	CEO
Name	:	IRINA GEVORGYAN
Credential	:
Telephone Number	:	818-476-0075

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/26/2007

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