Provider Demographics
NPI:1740234764
Name:EAGLE DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:EAGLE DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRANDZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-243-2501
Mailing Address - Street 1:401 N BRAND BLVD
Mailing Address - Street 2:825
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4427
Mailing Address - Country:US
Mailing Address - Phone:818-243-2501
Mailing Address - Fax:818-243-2511
Practice Address - Street 1:401 N BRAND BLVD
Practice Address - Street 2:825
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4427
Practice Address - Country:US
Practice Address - Phone:818-243-2501
Practice Address - Fax:818-243-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
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=========OtherTAX ID