Provider Demographics
NPI:1598003154
Name:BALAMUTYAN, NAZARET (RVT)
Entity Type:Individual
Prefix:
First Name:NAZARET
Middle Name:
Last Name:BALAMUTYAN
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 N SYCAMORE AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7557
Mailing Address - Country:US
Mailing Address - Phone:323-839-5523
Mailing Address - Fax:
Practice Address - Street 1:5300 SANTA MONICA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1258
Practice Address - Country:US
Practice Address - Phone:323-461-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1290192471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography