MEDICARE: HEALTH DIAGNOSTIC CENTER

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	2471S1302X	Sonography Radiologic Technologist	TG 427	CA

General Provider Information

NPI Number	:	1609955681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH DIAGNOSTIC CENTER

Provider Business Mailing Address
First Line	:	3171 LOS FELIZ BLVD
Second Line	:	212
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1527
Country	:	US
Telephone Number	:	323-662-2970
Fax Number	:	323-662-2970

Provider Business Practice Location Address
First Line	:	3171 LOS FELIZ BLVD
Second Line	:	212
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1527
Country	:	US
Telephone Number	:	323-662-2970
Fax Number	:	323-662-2970

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. GRACHIK HENRY KELOYAN
Credential	:
Telephone Number	:	323-662-2970

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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