Provider Demographics
NPI:1134382856
Name:UNICARE DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:UNICARE DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VANESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-252-9977
Mailing Address - Street 1:2500 WILSHIRE BLVD
Mailing Address - Street 2:912
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4303
Mailing Address - Country:US
Mailing Address - Phone:213-252-9977
Mailing Address - Fax:213-252-9377
Practice Address - Street 1:2500 WILSHIRE BLVD
Practice Address - Street 2:912
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4303
Practice Address - Country:US
Practice Address - Phone:213-252-9977
Practice Address - Fax:213-252-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA229442472E0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherOTHER
CA=========OtherEIN
CA=========OtherDIAGNOSTIC