Provider Demographics
NPI:1427305523
Name:INDUSTRIAL NEURO DIAGNOSTIC CENTER
Entity type:Organization
Organization Name:INDUSTRIAL NEURO DIAGNOSTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSS KERCHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-731-1199
Mailing Address - Street 1:1161 SPAZIER AVE
Mailing Address - Street 2:#7
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1161 SPAZIER AVE
Practice Address - Street 2:#7
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3724
Practice Address - Country:US
Practice Address - Phone:818-731-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory