Provider Demographics
NPI:1477694081
Name:MOBILE CARDIOVASCULAR ULTRASOUND SERVICES
Entity Type:Organization
Organization Name:MOBILE CARDIOVASCULAR ULTRASOUND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GOHAR
Authorized Official - Middle Name:GINA
Authorized Official - Last Name:PETROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-841-2209
Mailing Address - Street 1:103 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2253
Mailing Address - Country:US
Mailing Address - Phone:818-841-2209
Mailing Address - Fax:818-841-2298
Practice Address - Street 1:103 W ALAMEDA AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2253
Practice Address - Country:US
Practice Address - Phone:818-841-2209
Practice Address - Fax:818-841-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA937042471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX98381Medicare UPIN
CATG309Medicare ID - Type Unspecified