Provider Demographics
NPI:1700832847
Name:LUCKY DIAGNOSTIC,INC
Entity Type:Organization
Organization Name:LUCKY DIAGNOSTIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANDARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-860-0988
Mailing Address - Street 1:1600 N LA BREA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6934
Mailing Address - Country:US
Mailing Address - Phone:323-860-0988
Mailing Address - Fax:323-860-9088
Practice Address - Street 1:1600 N LA BREA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6934
Practice Address - Country:US
Practice Address - Phone:323-860-0988
Practice Address - Fax:323-860-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG500Medicare ID - Type UnspecifiedIDTF