Healthcare Provider Details

I. General information

NPI: 1457738460
Provider Name (Legal Business Name): MERI ANTOSSYAN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANTOSSYAN

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MCBEAN PKWY STE E24
VALENCIA CA
91355-4457
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 661-284-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: