Healthcare Provider Details

I. General information

NPI: 1750640967
Provider Name (Legal Business Name): PAD DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10823 ODELL AVE
SUNLAND CA
91040
US

IV. Provider business mailing address

10823 ODELL AVE
SUNLAND CA
91040
US

V. Phone/Fax

Practice location:
  • Phone: 818-875-4185
  • Fax: 818-875-4195
Mailing address:
  • Phone: 818-875-4185
  • Fax: 818-875-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ARMAN PETROSIAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 818-547-5799