Provider Demographics
NPI:1194947465
Name:BAGDASARYAN, ARMEN (ROT)
Entity type:Individual
Prefix:MR
First Name:ARMEN
Middle Name:
Last Name:BAGDASARYAN
Suffix:
Gender:M
Credentials:ROT
Other - Prefix:MRS
Other - First Name:MELINE
Other - Middle Name:
Other - Last Name:KHACHATRYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARMEN BAGDASARYAN
Mailing Address - Street 1:2625 W ALAMEDA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4815
Mailing Address - Country:US
Mailing Address - Phone:818-841-3936
Mailing Address - Fax:818-841-5964
Practice Address - Street 1:2625 WEST ALAMEDA AVE. SUITE 116
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505
Practice Address - Country:US
Practice Address - Phone:818-841-3936
Practice Address - Fax:818-841-5974
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHP81652247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist