Provider Demographics
NPI:1689814402
Name:AVISA MEDICAL CORP
Entity Type:Organization
Organization Name:AVISA MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-283-0464
Mailing Address - Street 1:6200 E CANYON RIM RD
Mailing Address - Street 2:109D
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4317
Mailing Address - Country:US
Mailing Address - Phone:714-283-0464
Mailing Address - Fax:714-283-0489
Practice Address - Street 1:6200 E CANYON RIM RD
Practice Address - Street 2:109D
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4317
Practice Address - Country:US
Practice Address - Phone:714-283-0464
Practice Address - Fax:714-283-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty