Provider Demographics
NPI:1477233898
Name:EVSLA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EVSLA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROUT
Authorized Official - Middle Name:
Authorized Official - Last Name:DERMENDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-791-8918
Mailing Address - Street 1:28049 SMYTH DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4023
Mailing Address - Country:US
Mailing Address - Phone:661-705-9706
Mailing Address - Fax:661-702-1701
Practice Address - Street 1:28049 SMYTH DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4023
Practice Address - Country:US
Practice Address - Phone:661-705-9706
Practice Address - Fax:661-702-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty