Provider Demographics
NPI:1306883806
Name:G & M DIAGNOSTIC CENTER, INC
Entity type:Organization
Organization Name:G & M DIAGNOSTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERBERYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-780-2654
Mailing Address - Street 1:13735 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2300
Mailing Address - Country:US
Mailing Address - Phone:818-780-2654
Mailing Address - Fax:818-780-2729
Practice Address - Street 1:13735 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2300
Practice Address - Country:US
Practice Address - Phone:818-780-2654
Practice Address - Fax:818-780-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG545Medicare ID - Type Unspecified