Healthcare Provider Details

I. General information

NPI: 1144256744
Provider Name (Legal Business Name): HOURGLASS DIAGNOSTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 ARDEN AVE SUITE 102
GLENDALE CA
91203-1129
US

IV. Provider business mailing address

372 ARDEN AVE SUITE 102
GLENDALE CA
91203-1129
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-5360
  • Fax:
Mailing address:
  • Phone: 818-240-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberTG547
License Number StateCA

VIII. Authorized Official

Name: SEDA GHAZARYAN
Title or Position: PRESIDENT
Credential:
Phone: 81824055360