Provider Demographics
NPI:1750395174
Name:ZETA DIAGNOSTIC INC
Entity type:Organization
Organization Name:ZETA DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MNATSAKANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-242-1276
Mailing Address - Street 1:610 N CENTRAL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1403
Mailing Address - Country:US
Mailing Address - Phone:818-242-1276
Mailing Address - Fax:818-242-0726
Practice Address - Street 1:610 N CENTRAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1403
Practice Address - Country:US
Practice Address - Phone:818-242-1276
Practice Address - Fax:818-242-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic