Healthcare Provider Details

I. General information

NPI: 1982646220
Provider Name (Legal Business Name): REO DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14521 TITUS ST SUITE #224
PANORAMA CITY CA
91402
US

IV. Provider business mailing address

14521 TITUS ST SUITE #224
PANORAMA CITY CA
91402
US

V. Phone/Fax

Practice location:
  • Phone: 818-692-1514
  • Fax: 818-988-0059
Mailing address:
  • Phone: 818-692-1514
  • Fax: 818-988-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. RAISA GOLKOVA
Title or Position: PRESIDENT
Credential:
Phone: 818-692-1514