Provider Demographics
NPI:1760424436
Name:VP DYNAMIC DIAGNOSTIC SERVICES INC.
Entity Type:Organization
Organization Name:VP DYNAMIC DIAGNOSTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-638-8385
Mailing Address - Street 1:600 W BROADWAY
Mailing Address - Street 2:# 260
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1022
Mailing Address - Country:US
Mailing Address - Phone:818-638-8385
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY
Practice Address - Street 2:# 260
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1022
Practice Address - Country:US
Practice Address - Phone:818-638-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Multi-Specialty
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG 317Medicare ID - Type UnspecifiedIDTF