LUCKY DIAGNOSTIC,INC , NPI 1700832847 — LOS ANGELES (CA)

NPI 1700832847

13+ Years Experience Organization

LUCKY DIAGNOSTIC,INC

05/26/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1700832847
NPI NUMBER

About LUCKY DIAGNOSTIC,INC

LUCKY DIAGNOSTIC,INC is a provider established in LOS ANGELES, CA. The NPI number of LUCKY DIAGNOSTIC,INC is 1700832847 and was assigned on 05/26/2006. The practitioners primary taxonomy code is: 246XC2903X .

Mailing address

  • City: LOS ANGELES
  • State: CA
  • Postal code: 900286934
  • Phone: 3238600988
  • Fax: 3238609088
  • Address: 1600 N LA BREA AVE
  • Address 2: SUITE 107

Primary Practice Address

  • Region : LOS ANGELES, CA
  • NPI : 1700832847
  • Phone : 3238600988
  • Fax : 3238609088
  • Postalcode : 900286934
  • Address : 1600 N LA BREA AVE SUITE 107

Provider taxonomy - Specialist/Technologist Cardiovascular

  • Taxonomy code: 246XC2903X

The primary taxonomy switch is Not Answered.

Taxonomy group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP.

Healthcare provider taxonomy #2 - Specialist/Technologist Cardiovascular

  • Taxonomy code: 246XS1301X

The primary taxonomy switch is Not Answered.

Contacts:

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  • LUCKY DIAGNOSTIC,INC
  • Address : 1600 N LA BREA AVE SUITE 107
  • Region : LOS ANGELES, CA
  • NPI : 1700832847
  • Phone : 3238600988
  • Fax : 3238609088
  • Postalcode : 900286934

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 3238600988
  • Title or position : CEO

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address1600 N LA BREA AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 107
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLOS ANGELES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCA
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code900286934
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3238600988
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3238609088
The fax number associated with the location address of the provider being identified.
NPI1700832847
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1246XC2903X
Provider Enumeration Date05/26/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)LUCKY DIAGNOSTIC,INC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address1600 N LA BREA AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSUITE 107
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameLOS ANGELES
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameCA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code900286934
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3238600988
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number3238609088
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Authorized Official Last NameSPANDARYAN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameMARIYA
The first name of the authorized official
Authorized Official Title or PositionCEO
The title or position of the authorized official
Authorized Official Name Prefix TextMISS
Authorized Official Name Prefix Text
Authorized Official Telephone Number3238600988
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1246XC2903X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Specialist/Technologist Cardiovascular
Healthcare Provider Primary Taxonomy Switch 1X
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2246XS1301X
Healthcare Provider Taxonomy 2Specialist/Technologist Cardiovascular
Healthcare Provider Primary Taxonomy Switch 2X
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
X

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