Provider Demographics
NPI:1710115779
Name:STAT DIAGNOSTIC SERVICE, INC
Entity Type:Organization
Organization Name:STAT DIAGNOSTIC SERVICE, INC
Other - Org Name:STAT MED TRANSIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RCP, MBA
Authorized Official - Phone:562-622-1002
Mailing Address - Street 1:701 E 28TH ST
Mailing Address - Street 2:SUITE 419
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-622-1002
Mailing Address - Fax:562-622-1058
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:SUITE 419
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-622-1002
Practice Address - Fax:562-622-1058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAT DIAGNOSTIC SERVICE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)