Healthcare Provider Details

I. General information

NPI: 1801148358
Provider Name (Legal Business Name): SIRAF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12918 SHERMAN WAY 130
NORTH HOLLYWOOD CA
91605-4953
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 Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

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