Healthcare Provider Details

I. General information

NPI: 1003136565
Provider Name (Legal Business Name): ALBERT A PETROSSIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 E SPRING ST STE 260
LONG BEACH CA
90815-1454
US

IV. Provider business mailing address

6226 E SPRING ST STE 260
LONG BEACH CA
90815-1454
US

V. Phone/Fax

Practice location:
  • Phone: 562-283-4876
  • Fax: 562-731-2926
Mailing address:
  • Phone: 562-283-4876
  • Fax: 562-731-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022439
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number136810
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA136810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: