Provider Demographics
NPI:1023674421
Name:EXPO DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:EXPO DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-717-4132
Mailing Address - Street 1:8619 RECEDA BLVD.
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:818-952-2999
Mailing Address - Fax:323-978-6999
Practice Address - Street 1:8619 RECEDA BLVD.
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-952-2999
Practice Address - Fax:323-978-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile