Healthcare Provider Details

I. General information

NPI: 1417012147
Provider Name (Legal Business Name): PRO-CARE DIAGNOSTIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E WILSON AVE 307
GLENDALE CA
91206-4351
US

IV. Provider business mailing address

512 E WILSON AVE 307
GLENDALE CA
91206-4351
US

V. Phone/Fax

Practice location:
  • Phone: 818-638-8580
  • Fax:
Mailing address:
  • Phone: 818-638-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: PIRUZA LISA BALYAN
Title or Position: CEO
Credential:
Phone: 818-638-8580