Provider Demographics
NPI:1477585602
Name:SPECTRUM DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:SPECTRUM DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEVORG
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-977-1399
Mailing Address - Street 1:1127 WILSHIRE BLVD STE 1507
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4006
Mailing Address - Country:US
Mailing Address - Phone:213-977-1399
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1507
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4006
Practice Address - Country:US
Practice Address - Phone:213-977-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN
CATG379Medicare PIN