Provider Demographics
NPI:1366497208
Name:CRISTAL DIAGNOSTIC SERVICE, INC
Entity Type:Organization
Organization Name:CRISTAL DIAGNOSTIC SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-988-8225
Mailing Address - Street 1:7017 VAN NUYS BLVD
Mailing Address - Street 2:#3
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3095
Mailing Address - Country:US
Mailing Address - Phone:818-988-8225
Mailing Address - Fax:818-988-8224
Practice Address - Street 1:7017 VAN NUYS BLVD
Practice Address - Street 2:#3
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3095
Practice Address - Country:US
Practice Address - Phone:818-988-8225
Practice Address - Fax:818-988-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG423Medicare ID - Type Unspecified