MEDICARE: SUPER CARE 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	247200000X	Other Technician

General Provider Information

NPI Number	:	1942256409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER CARE DIAGNOSTIC SERVICES, INC

Provider Business Mailing Address
First Line	:	1749 COLORADO BLVD
Second Line	:	C
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1348
Country	:	US
Telephone Number	:	323-255-9777
Fax Number	:	323-255-9776

Provider Business Practice Location Address
First Line	:	1749 COLORADO BLVD
Second Line	:	C
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1348
Country	:	US
Telephone Number	:	323-255-9777
Fax Number	:	323-255-9776

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SAMVEL ABRAMYAN
Credential	:
Telephone Number	:	323-255-9777

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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