Provider Demographics
NPI:1790885606
Name:HEALTHY CHOICE DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:HEALTHY CHOICE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTOVAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-8422
Mailing Address - Street 1:6657 RESEDA BLVD.,
Mailing Address - Street 2:STE # 204
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5333
Mailing Address - Country:US
Mailing Address - Phone:818-345-8422
Mailing Address - Fax:818-345-8829
Practice Address - Street 1:6657 RESEDA BLVD.,
Practice Address - Street 2:STE # 204
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5333
Practice Address - Country:US
Practice Address - Phone:818-345-8422
Practice Address - Fax:818-345-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG416Medicare ID - Type UnspecifiedIDTF