Healthcare Provider Details

I. General information

NPI: 1326393059
Provider Name (Legal Business Name): NOVA DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17404 HORACE ST
GRANADA HILLS CA
91344
US

IV. Provider business mailing address

12918 SHERMAN WAY 130
NORTH HOLLYWOOD CA
91605-4953
US

V. Phone/Fax

Practice location:
  • Phone: 818-497-3476
  • Fax:
Mailing address:
  • Phone: 818-497-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTINA ALEKSANYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-497-3476