MEDICARE: ARA MNATSAKANIAN AM IMAGING NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1083150593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARA MNATSAKANIAN AM IMAGING NETWORK

Provider Business Mailing Address
First Line	:	655 N CENTRAL AVE
Second Line	:	1700
City	:	GLENDALE
State	:	CA
Zip	:	91203-1422
Country	:	US
Telephone Number	:	818-649-7661
Fax Number	:	818-649-7663

Provider Business Practice Location Address
First Line	:	655 N CENTRAL AVE
Second Line	:	1700
City	:	GLENDALE
State	:	CA
Zip	:	91203-1422
Country	:	US
Telephone Number	:	818-649-7661
Fax Number	:	818-649-7663

Authorized Official
Title or Position	:	CEO
Name	:	ARA MNATSAKANIAN
Credential	:
Telephone Number	:	818-800-5577

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	05/07/2021

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