=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689506552
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COREVION DIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2026
-----------------------------------------------------
Last Update Date | 06/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16250 VENTURA BLVD STE 165
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-622-9550
-----------------------------------------------------
Fax | 312-395-7290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16250 VENTURA BLVD STE 165
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-622-9550
-----------------------------------------------------
Fax | 312-395-7290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMMED AFTAB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 307-622-9550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------