Healthcare Provider Details

I. General information

NPI: 1710504055
Provider Name (Legal Business Name): VICTORY DIAGNOSTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 10/01/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 VICTORY BLVD # 407
NORTH HOLLYWOOD CA
91606-3199
US

IV. Provider business mailing address

12444 VICTORY BLVD # 406
NORTH HOLLYWOOD CA
91606-3199
US

V. Phone/Fax

Practice location:
  • Phone: 747-256-5460
  • Fax:
Mailing address:
  • Phone: 747-256-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VARTAN SARKISIAN
Title or Position: CEO
Credential:
Phone: 747-203-9067