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General NPI Number Information
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NPI Number | 1699048413
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Entity Type | Organization
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Legal Business Name | MEDITOX SERVICES INC.
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 410 ARDEN AVE STE 102
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City | GLENDALE
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State | CA
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Zip | 91203-4005
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Country | US
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Telephone | 818-243-3626
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Fax | 888-664-5349
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Provider Business Mailing Address
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Address Line | PO BOX 4677
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City | GLENDALE
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State | CA
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Zip | 91222-0677
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Country | US
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Telephone | 818-243-3626
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Fax | 888-664-5349
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Authorized Official
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Title or Position | OWNER
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Name | ZAVEN KHANBEKYAN
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Credential | C.E.O.
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Telephone | 818-243-3626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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