Healthcare Provider Details

I. General information

NPI: 1609284660
Provider Name (Legal Business Name): ARMEN AIVAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 DEER CREEK LN
GLENDALE CA
91208-1166
US

IV. Provider business mailing address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2345
  • Fax:
Mailing address:
  • Phone: 317-806-8260
  • Fax: 317-806-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01083380A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA138112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: