Provider Demographics
NPI:1194839043
Name:ROYAL DIAGNOSTIC INC
Entity type:Organization
Organization Name:ROYAL DIAGNOSTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-373-7000
Mailing Address - Street 1:14440 HAMLIN STREET
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1409
Mailing Address - Country:US
Mailing Address - Phone:818-373-7000
Mailing Address - Fax:818-373-7001
Practice Address - Street 1:14440 HAMLIN STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1409
Practice Address - Country:US
Practice Address - Phone:818-373-7000
Practice Address - Fax:818-373-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02351GMedicaid
CA4128410001Medicare NSC