Provider Demographics
NPI:1588769806
Name:ATLAS DIAGNOSTIC SERVICES,INC
Entity type:Organization
Organization Name:ATLAS DIAGNOSTIC SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VISHNEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-506-6663
Mailing Address - Street 1:3959 LAUREL CYN BL.
Mailing Address - Street 2:STE 'C'
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3711
Mailing Address - Country:US
Mailing Address - Phone:818-506-6663
Mailing Address - Fax:818-506-2505
Practice Address - Street 1:3959 LAUREL CYN BL.
Practice Address - Street 2:STE 'C'
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3711
Practice Address - Country:US
Practice Address - Phone:818-506-6663
Practice Address - Fax:818-506-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATD068261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD068Medicare ID - Type Unspecified