Provider Demographics
NPI:1265717938
Name:BALANCE DREAM DIAGNOSTIC INC
Entity type:Organization
Organization Name:BALANCE DREAM DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXSANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAPETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-736-5511
Mailing Address - Street 1:1915 W GLENOAKS BLVD
Mailing Address - Street 2:101A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1541
Mailing Address - Country:US
Mailing Address - Phone:818-736-5511
Mailing Address - Fax:
Practice Address - Street 1:1915 W GLENOAKS BLVD
Practice Address - Street 2:101A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1541
Practice Address - Country:US
Practice Address - Phone:818-736-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG62117OtherMEDICAL BOARD OF CALIFORNIA