Healthcare Provider Details

I. General information

NPI: 1497269369
Provider Name (Legal Business Name): MD ULTRASOUND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 E OLIVE AVE STE 102
BURBANK CA
91502-1228
US

IV. Provider business mailing address

356 E OLIVE AVE STE 102
BURBANK CA
91502-1228
US

V. Phone/Fax

Practice location:
  • Phone: 747-229-9000
  • Fax:
Mailing address:
  • Phone: 747-229-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number145997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number192064
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number199625
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number145997
License Number StateCA

VIII. Authorized Official

Name: ARMAN ANTANYAN
Title or Position: CEO
Credential: RVT
Phone: 323-770-3880