Provider Demographics
NPI:1417012147
Name:PRO-CARE DIAGNOSTIC SERVICES INC.
Entity Type:Organization
Organization Name:PRO-CARE DIAGNOSTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PIRUZA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:BALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-638-8580
Mailing Address - Street 1:512 E WILSON AVE
Mailing Address - Street 2:307
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4351
Mailing Address - Country:US
Mailing Address - Phone:818-638-8580
Mailing Address - Fax:
Practice Address - Street 1:512 E WILSON AVE
Practice Address - Street 2:307
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4351
Practice Address - Country:US
Practice Address - Phone:818-638-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG465Medicare ID - Type UnspecifiedIDTF