Provider Demographics
NPI:1528355369
Name:GLOBAL NEURODIAGNOSTIC
Entity type:Organization
Organization Name:GLOBAL NEURODIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-955-5150
Mailing Address - Street 1:15201 SANTA GERTRUDES AVE Y202
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638
Mailing Address - Country:US
Mailing Address - Phone:818-955-5150
Mailing Address - Fax:818-955-5788
Practice Address - Street 1:15201 SANTA GERTRUDES AVE # Y202
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5043
Practice Address - Country:US
Practice Address - Phone:818-955-5150
Practice Address - Fax:818-955-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory