Provider Demographics
NPI:1427307081
Name:ST RITA IMAGING CENTER INC
Entity type:Organization
Organization Name:ST RITA IMAGING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-937-9280
Mailing Address - Street 1:541 WEST COLORADO ST
Mailing Address - Street 2:105
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-937-9280
Mailing Address - Fax:818-937-9281
Practice Address - Street 1:541 WEST COLORADO ST
Practice Address - Street 2:105
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3638
Practice Address - Country:US
Practice Address - Phone:818-937-9280
Practice Address - Fax:818-937-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31205Medicare Oscar/Certification