Healthcare Provider Details

I. General information

NPI: 1689888653
Provider Name (Legal Business Name): GNA DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 E GARFIELD AVE
GLENDALE CA
91205-2660
US

IV. Provider business mailing address

1386 E GARFIELD AVE
GLENDALE CA
91205-2660
US

V. Phone/Fax

Practice location:
  • Phone: 818-281-8091
  • Fax:
Mailing address:
  • Phone: 818-281-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GRANT KOSTIKIAN
Title or Position: OWNER
Credential:
Phone: 818-281-8091