Healthcare Provider Details

I. General information

NPI: 1952648909
Provider Name (Legal Business Name): A&N DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 SANTA MONICA BLVD STE 200
LOS ANGELES CA
90029-1258
US

IV. Provider business mailing address

1339 N SYCAMORE AVE APT 102
LOS ANGELES CA
90028-7557
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-5882
  • Fax:
Mailing address:
  • Phone: 323-839-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number110793
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number129019
License Number StateCA

VIII. Authorized Official

Name: NAZARET BALAMUTYAN
Title or Position: OWNER
Credential: RVT
Phone: 323-839-5523