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General NPI Number Information
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NPI Number | 1225316284
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Entity Type | Organization
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Legal Business Name | MAGNOLIA NEURODIAGNOSTIC INC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 4020 W MAGNOLIA BLVD E
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City | BURBANK
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State | CA
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Zip | 91505-2828
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Country | US
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Telephone | 818-260-0595
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Fax | 818-260-8792
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Provider Business Mailing Address
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Address Line | 4020 W MAGNOLIA BLVD E
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City | BURBANK
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State | CA
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Zip | 91505-2828
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Country | US
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Telephone | 818-260-0595
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Fax | 818-260-8792
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MS. MILENA MELKONYAN
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Credential |
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Telephone | 818-260-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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