Provider Demographics
NPI:1114216595
Name:BAGHDASARYAN, EDGAR
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:BAGHDASARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2765
Mailing Address - Country:US
Mailing Address - Phone:888-520-0220
Mailing Address - Fax:818-273-9523
Practice Address - Street 1:6501 FOOTHILL BLVD
Practice Address - Street 2:SUITE 201B
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2765
Practice Address - Country:US
Practice Address - Phone:888-520-0220
Practice Address - Fax:818-273-9523
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)