Healthcare Provider Details

I. General information

NPI: 1770180945
Provider Name (Legal Business Name): BELLONA DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 BELLINGHAM AVE STE G
NORTH HOLLYWOOD CA
91606-1429
US

IV. Provider business mailing address

6450 BELLINGHAM AVE STE G
NORTH HOLLYWOOD CA
91606-1429
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 818-752-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: ACHKHEN MARTIROSYAN
Title or Position: CEO
Credential:
Phone: 747-295-8536