MEDICARE: DVT DIAGNOSTIC SERVICES 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	2471S1302X	Sonography Radiologic Technologist	105521	CA

General Provider Information

NPI Number	:	1649310707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DVT DIAGNOSTIC SERVICES INC

Provider Business Mailing Address
First Line	:	20376 VIA BOTTICELLI
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4437
Country	:	US
Telephone Number	:	818-534-8288
Fax Number	:	818-357-5689

Provider Business Practice Location Address
First Line	:	7345 TOPANGA CANYON BLVD # 240
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1244
Country	:	US
Telephone Number	:	818-534-8288
Fax Number	:	818-357-5689

Authorized Official
Title or Position	:	CEO / OWNER
Name	:	DAVIT BAKHCHINYAN
Credential	:	RDMS / RVT / MS-RIS
Telephone Number	:	818-534-8288

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	06/05/2023

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