Provider Demographics
NPI:1407160526
Name:AVIA DIALYSIS CENTER, INC
Entity Type:Organization
Organization Name:AVIA DIALYSIS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:OGANESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-673-5245
Mailing Address - Street 1:15211 VANOWEN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3666
Mailing Address - Country:US
Mailing Address - Phone:513-673-5245
Mailing Address - Fax:866-352-4339
Practice Address - Street 1:15211 VANOWEN ST STE 204
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3666
Practice Address - Country:US
Practice Address - Phone:513-673-5245
Practice Address - Fax:866-352-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment