Healthcare Provider Details

I. General information

NPI: 1619472024
Provider Name (Legal Business Name): PROFESSIONAL DIAGNOSTIC SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16940 CHATSWORTH ST UNIT 303
GRANADA HILLS CA
91344-5864
US

IV. Provider business mailing address

16940 CHATSWORTH ST UNIT 303
GRANADA HILLS CA
91344-5864
US

V. Phone/Fax

Practice location:
  • Phone: 747-256-9774
  • Fax: 181-484-2077
Mailing address:
  • Phone: 747-256-9774
  • Fax: 181-484-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA GRIGORYAN
Title or Position: CEO
Credential:
Phone: 747-256-9774