Healthcare Provider Details

I. General information

NPI: 1902132277
Provider Name (Legal Business Name): PRIMARY HEALTHCARE DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 STINE RD SUITE 409
BAKERSFIELD CA
93313-2308
US

IV. Provider business mailing address

4300 STINE RD SUITE 409
BAKERSFIELD CA
93313-2308
US

V. Phone/Fax

Practice location:
  • Phone: 661-834-4042
  • Fax: 661-834-4962
Mailing address:
  • Phone: 661-834-4042
  • Fax: 661-834-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License NumberC43367
License Number StateCA

VIII. Authorized Official

Name: NAZARET VARDANYAN
Title or Position: PRESIDENT
Credential:
Phone: 661-834-4042