MEDICARE: GLOBAL NEURODIAGNOSTIC

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

General Provider Information

NPI Number	:	1528355369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL NEURODIAGNOSTIC

Provider Business Mailing Address
First Line	:	15201 SANTA GERTRUDES AVE Y202
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638
Country	:	US
Telephone Number	:	818-955-5150
Fax Number	:	818-955-5788

Provider Business Practice Location Address
First Line	:	15201 SANTA GERTRUDES AVE # Y202
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-5043
Country	:	US
Telephone Number	:	818-955-5150
Fax Number	:	818-955-5788

Authorized Official
Title or Position	:	BILLING ADMINISTRATION
Name	:	KARINE SARGSYAN
Credential	:
Telephone Number	:	818-955-5150

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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Directions to “GLOBAL NEURODIAGNOSTIC ” Practice Location

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