Provider Demographics
NPI:1265532659
Name:ARRAY DIAGNOSTICS INC.
Entity type:Organization
Organization Name:ARRAY DIAGNOSTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-846-8666
Mailing Address - Street 1:640 N KEYSTONE ST
Mailing Address - Street 2:UNIT # B
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1900
Mailing Address - Country:US
Mailing Address - Phone:818-846-8666
Mailing Address - Fax:818-846-8665
Practice Address - Street 1:640 N. KEYSTONE ST.
Practice Address - Street 2:UNIT # B
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506
Practice Address - Country:US
Practice Address - Phone:818-846-8666
Practice Address - Fax:818-846-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1200X
AZ261QS1200X
NV261QS1200X
225B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265532659Medicaid
CATG413Medicare PIN
CADD088AMedicare PIN