Healthcare Provider Details

I. General information

NPI: 1831608165
Provider Name (Legal Business Name): TALLIN MARTIROSSIAN PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S 1ST ST STE 305
BURBANK CA
91502-1961
US

IV. Provider business mailing address

12272 WILLOWBEND LN
SYLMAR CA
91342-5150
US

V. Phone/Fax

Practice location:
  • Phone: 626-708-0496
  • Fax: 626-714-2060
Mailing address:
  • Phone: 626-708-0496
  • Fax: 626-714-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6978
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55145
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6978
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55145
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number55145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: