Provider Demographics
NPI:1376708727
Name:ADVANCED DIAGNOSTIC MEDICAL CLINIC,INC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC MEDICAL CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-828-4255
Mailing Address - Street 1:6420 RICHMOND AVE STE 580
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5922
Mailing Address - Country:US
Mailing Address - Phone:323-828-4255
Mailing Address - Fax:818-767-7228
Practice Address - Street 1:6420 RICHMOND AVE STE 580
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5922
Practice Address - Country:US
Practice Address - Phone:323-828-4255
Practice Address - Fax:818-767-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty