MEDICARE: PRIME DIAGNOSTICS 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	305S00000X	Point of Service	77551	AZ

General Provider Information

NPI Number	:	1356388847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	6240 LAUREL CANYON BLVD
Second Line	:	SUITE B
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3267
Country	:	US
Telephone Number	:	818-985-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6240 LAUREL CANYON BLVD
Second Line	:	SUITE B
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3267
Country	:	US
Telephone Number	:	818-985-6900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANNA LYNOVA
Credential	:
Telephone Number	:	818-985-6900

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/22/2020

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