Healthcare Provider Details

I. General information

NPI: 1417567710
Provider Name (Legal Business Name): FAMILY MEDICAL DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD STE 356
RESEDA CA
91335-6308
US

IV. Provider business mailing address

19231 VICTORY BLVD STE 356
RESEDA CA
91335-6308
US

V. Phone/Fax

Practice location:
  • Phone: 747-265-6197
  • Fax: 747-265-6098
Mailing address:
  • Phone: 747-265-6197
  • Fax: 747-265-6098

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 Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ASPRAM AZNAVOUR
Title or Position: PRESIDENT
Credential:
Phone: 747-240-0747