Healthcare Provider Details

I. General information

NPI: 1689506552
Provider Name (Legal Business Name): COREVION DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 VENTURA BLVD STE 165
ENCINO CA
91436-2273
US

IV. Provider business mailing address

16250 VENTURA BLVD STE 165
ENCINO CA
91436-2273
US

V. Phone/Fax

Practice location:
  • Phone: 307-622-9550
  • Fax: 312-395-7290
Mailing address:
  • Phone: 307-622-9550
  • Fax: 312-395-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED AFTAB
Title or Position: OWNER
Credential:
Phone: 307-622-9550