Healthcare Provider Details

I. General information

NPI: 1356388847
Provider Name (Legal Business Name): PRIME DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 LAUREL CANYON BLVD SUITE B
NORTH HOLLYWOOD CA
91606-3267
US

IV. Provider business mailing address

6240 LAUREL CANYON BLVD SUITE B
NORTH HOLLYWOOD CA
91606-3267
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-6900
  • Fax:
Mailing address:
  • Phone: 818-985-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number77551
License Number StateAZ

VIII. Authorized Official

Name: ANNA LYNOVA
Title or Position: PRESIDENT
Credential:
Phone: 818-985-6900