Portable Diagnostic Imaging Inc

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

License

RHF00103590 Issued in CA

Legal business name

PORTABLE DIAGNOSTIC IMAGING INC

Practice address

3504 West Magnolia Blvd
Second Floor, Suite a
Burbank, CA 91505-2911

Phone

(818) 823-6241

NPI assigned

Oct 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mikhail Muradyan, RT/AART

Title

Radiological Technologist

Phone

(818) 823-6241

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Portable X-ray supplier certification: CCN 05X0010057

Legal name

PORTABLE DIAGNOSTIC IMAGING

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Aug 21, 2019

Last certification

Aug 21, 2019

Ownership / control type

Individual

Facility address

3504 W Magnolia Blvd 2Ndfloor Ste a (RHB 79234)
Burbank, CA 91505

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1336698257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3504 WEST MAGNOLIA BLVD",
            "address_2": "SECOND FLOOR, SUITE A",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915055501",
            "telephone_number": "818-823-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3504 WEST MAGNOLIA BLVD",
            "address_2": "SECOND FLOOR, SUITE A",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915052911",
            "telephone_number": "818-823-6241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE DIAGNOSTIC IMAGING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-04",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "MURADYAN",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "RADIOLOGICAL TECHNOLOGIST",
        "authorized_official_telephone_number": "818-823-6241",
        "authorized_official_credential": "RT/AART"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "CA",
            "license": "RHF00103590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Burbank, CA
• Providers in Burbank, CA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.