Provider Demographics
NPI:1255823589
Name:SO CAL MOBILE DIAGNOSTICS
Entity type:Organization
Organization Name:SO CAL MOBILE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANAHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUTYUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-359-3515
Mailing Address - Street 1:10929 VANOWEN ST STE 114
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-6433
Mailing Address - Country:US
Mailing Address - Phone:310-359-3515
Mailing Address - Fax:
Practice Address - Street 1:10929 VANOWEN ST STE 114
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-6433
Practice Address - Country:US
Practice Address - Phone:310-359-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile