MEDICARE: NAIRA BAGDASARIAN RDMS, RVT, RDCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471S1302X	Sonography Radiologic Technologist	2000091-320	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2000091-320	OTHER	NV	LICENSE #

General Provider Information

NPI Number	:	1285894139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAIRA BAGDASARIAN RDMS, RVT, RDCS

Provider Business Mailing Address
First Line	:	6380 NARROW ISTHMUS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6411
Country	:	US
Telephone Number	:	702-460-1941
Fax Number	:	702-252-5044

Provider Business Practice Location Address
First Line	:	6380 NARROW ISTHMUS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6411
Country	:	US
Telephone Number	:	702-460-1941
Fax Number	:	702-252-5044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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