Organization
MIKWAVES DIAGNOSTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RIDJAN (DIRECTOR)
(818) 509-8808
Entity
Organization
Contact information
Practice address
11120 BURBANK BLVD, SPACE 1A, NORTH HOLLYWOOD, CA 91601-5708
(818) 509-8808
(818) 509-8806
Mailing address
11120 BURBANK BLVD, SPACE 1A, NORTH HOLLYWOOD, CA 91601-5708
(818) 509-8808
(818) 509-8806
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
0002055859-0001-1
CA
Other
Enumeration date
02/13/2007
Last updated
08/22/2020
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