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General NPI Number Information
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NPI Number | 1306936174
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Entity Type | Organization
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Legal Business Name | TARZANA DIAGNOSTIC INC.
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5250 SANTA MONICA BLVD STE 211
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City | LOS ANGELES
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State | CA
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Zip | 90029-1252
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Country | US
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Telephone | 323-668-2572
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Fax | 323-668-2573
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Provider Business Mailing Address
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Address Line | 5250 SANTA MONICA BLVD STE 211
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City | LOS ANGELES
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State | CA
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Zip | 90029-1252
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Country | US
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Telephone | 323-668-2572
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Fax | 323-668-2573
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Authorized Official
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Title or Position | OWNER
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Name | GOKOR ARAKELYAN
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Credential |
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Telephone | 323-668-2572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | TG260
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License Number State | CA
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