Provider Demographics
NPI:1548349640
Name:EXPERT MED DIAGNOSTIC, INC
Entity type:Organization
Organization Name:EXPERT MED DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARSHALUYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-640-4414
Mailing Address - Street 1:6904 VANTAGE AVE
Mailing Address - Street 2:UNIT #121
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-6837
Mailing Address - Country:US
Mailing Address - Phone:818-640-4414
Mailing Address - Fax:818-503-0144
Practice Address - Street 1:6904 VANTAGE AVE
Practice Address - Street 2:UNIT #121
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-6837
Practice Address - Country:US
Practice Address - Phone:818-640-4414
Practice Address - Fax:818-503-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG552Medicare ID - Type UnspecifiedIDTF