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Organization
MEDIAID DIAGNOSTIC INC
Active
Organization
MEDIAID DIAGNOSTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANAIT GRIGORIAN (CEO)
13107747747
Entity
Organization
Contact information
Practice address
8127 MELROSE AVE STE 2, LOS ANGELES, CA 90046-7030
(131) 077-4774
Mailing address
PO BOX 1429, HOLLYWOOD, CA 90078-1429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
102999
CA
Other
Enumeration date
03/01/2007
Last updated
08/22/2020
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