Healthcare Provider Details

I. General information

NPI: 1194947465
Provider Name (Legal Business Name): ARMEN BAGDASARYAN R.O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MELINE KHACHATRYAN ARMEN BAGDASARYAN

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 WEST ALAMEDA AVE. SUITE 116
BURBANK CA
91505
US

IV. Provider business mailing address

2625 W ALAMEDA AVE STE 116
BURBANK CA
91505-4815
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-3936
  • Fax: 818-841-5974
Mailing address:
  • Phone: 818-841-3936
  • Fax: 818-841-5964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHP81652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: