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General NPI Number Information
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NPI Number | 1598003154
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Entity Type | Individual
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Provider Name | NAZARET BALAMUTYAN RVT
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Gender | Male
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 5300 SANTA MONICA BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90029-1258
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Country | US
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Telephone | 323-461-5882
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Fax |
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Provider Business Mailing Address
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Address Line | 1339 N SYCAMORE AVE APT 102
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City | LOS ANGELES
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State | CA
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Zip | 90028-7557
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Country | US
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Telephone | 323-839-5523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 129019
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License Number State | CA
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