Organization
SKY DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX KOZONASHVILI (OWNER)
(323) 610-1035
Entity
Organization
Contact information
Practice address
1825 N GRAMERCY PL, # 204, LOS ANGELES, CA 90028-5870
(323) 466-5018
Mailing address
1825 N GRAMERCY PL, # 204, LOS ANGELES, CA 90028-5870
(323) 466-5018
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TG440
IDTF PROVIDER NUMBER
CA
Enumeration date
07/27/2006
Last updated
08/22/2020
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