Healthcare Provider Details

I. General information

NPI: 1972251999
Provider Name (Legal Business Name): AGDX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 VICTORY BLVD STE 502C
NORTH HOLLYWOOD CA
91606-3199
US

IV. Provider business mailing address

12444 VICTORY BLVD STE 502C
NORTH HOLLYWOOD CA
91606-3199
US

V. Phone/Fax

Practice location:
  • Phone: 818-516-8899
  • Fax:
Mailing address:
  • Phone: 818-516-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: AVETIS MARTIROSYAN
Title or Position: CEO
Credential:
Phone: 818-516-8899