MEDICARE: ULTRATECH SERVICES

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	:	1508336371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRATECH SERVICES

Provider Business Mailing Address
First Line	:	118 W STOCKER ST # 3
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2509
Country	:	US
Telephone Number	:	818-484-7351
Fax Number	:	818-484-7352

Provider Business Practice Location Address
First Line	:	118 W STOCKER ST # 3
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2509
Country	:	US
Telephone Number	:	818-484-7351
Fax Number	:	818-484-7352

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	MIKAEL OVSEPIAN
Credential	:
Telephone Number	:	818-484-7352

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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Directions to “ULTRATECH SERVICES ” Practice Location

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