MEDICARE: TARZANA DIAGNOSTIC INC.

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	291U00000X	Clinical Medical Laboratory	TG260	CA

General Provider Information

NPI Number	:	1306936174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARZANA DIAGNOSTIC INC.

Provider Business Mailing Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	STE 211
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1252
Country	:	US
Telephone Number	:	323-668-2572
Fax Number	:	323-668-2573

Provider Business Practice Location Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	STE 211
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1252
Country	:	US
Telephone Number	:	323-668-2572
Fax Number	:	323-668-2573

Authorized Official
Title or Position	:	OWNER
Name	:	GOKOR ARAKELYAN
Credential	:
Telephone Number	:	323-668-2572

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/22/2020

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Directions to “TARZANA DIAGNOSTIC INC. ” Practice Location

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