Provider Demographics
NPI:1730261264
Name:VIO DIAGNOSTICS INC
Entity type:Organization
Organization Name:VIO DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTYUSHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-662-3327
Mailing Address - Street 1:1146 N CENTRAL AVE
Mailing Address - Street 2:139
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3171 LOS FELIZ BLVD
Practice Address - Street 2:211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1527
Practice Address - Country:US
Practice Address - Phone:323-662-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG553Medicare ID - Type UnspecifiedIDTF