Provider Demographics
NPI:1952648909
Name:A&N DIAGNOSTIC
Entity Type:Organization
Organization Name:A&N DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAZARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAMUTYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:323-839-5523
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1107932471S1302X
CA1290192471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty