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General NPI Number Information
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NPI Number | 1902291222
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY DIAGNOSTIC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 560 W PUTNAM AVE SUITE 3
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City | PORTERVILLE
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State | CA
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Zip | 93257-3269
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Country | US
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Telephone | 818-571-4338
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Fax |
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Provider Business Mailing Address
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Address Line | 560 W PUTNAM AVE SUITE 3
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City | PORTERVILLE
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State | CA
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Zip | 93257-3269
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Country | US
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Telephone | 818-571-4338
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Fax |
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Authorized Official
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Title or Position | OWNER/GENERAL MANAGER
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Name | ANNA SAFRAZBEKIAN
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Credential |
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Telephone | 818-571-4338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State | CA
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