Provider Demographics
NPI:1780250209
Name:ULTRAMED DIAGNOSTIC RADIOLOGY INC
Entity type:Organization
Organization Name:ULTRAMED DIAGNOSTIC RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SER-MANUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-290-3268
Mailing Address - Street 1:6613 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4517
Mailing Address - Country:US
Mailing Address - Phone:818-290-3268
Mailing Address - Fax:818-290-3274
Practice Address - Street 1:6613 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4517
Practice Address - Country:US
Practice Address - Phone:818-290-3268
Practice Address - Fax:818-290-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty