Exevia Diagnostics LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

EXEVIA DIAGNOSTICS LLC

Practice address

771 E Southlake Blvd Ste 217
Southlake, TX 76092-6989

Phone

(469) 638-8875

NPI assigned

Jun 2, 2026

Last updated

Jun 2, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ani Petrosyan

Title

Owner

Phone

(213) 474-7306

Specialties & licenses 2

Addresses

Tax ID family

Exevia Diagnostics LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Exevia Diagnostics LLC

  • Diagnostic Radiology Physician
  • Southlake, TX
  • NPI 1093662561
  NPD tax ID
• Exevia Diagnostics LLC

  • Durable Medical Equipment & Medical Supplies
  • Southlake, TX
  • NPI 1356298822
  NPD tax ID
• Exevia Diagnostics LLC

  • Urgent Care Clinic/Center
  • Southlake, TX
  • NPI 1457283566
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1780358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1639001746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 E SOUTHLAKE BLVD STE 217",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 E SOUTHLAKE BLVD STE 217",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926989",
            "telephone_number": "469-638-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXEVIA DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-02",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "PETROSYAN",
        "authorized_official_first_name": "ANI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "213-474-7306"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wyatt R Evans, PHD
• Exevia Diagnostics LLC
• Exevia Diagnostics LLC
• Exevia Diagnostics LLC
• Exevia Diagnostics LLC
• Eyes on Southlake PLLC
• Ezmed
• Deborah M Fabel
• Facial Plastic Surgery Institute, PLLC
• Evin Leann Fahey, M.S.CCC-SLP

• Multi-Specialty Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Multi-Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.