Healthcare Provider Details

I. General information

NPI: 1770086522
Provider Name (Legal Business Name): SOSSE BEDROSSIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N BEAUDRY AVE
LOS ANGELES CA
90012-2009
US

IV. Provider business mailing address

19360 RINALDI ST # 658
PORTER RANCH CA
91326-1607
US

V. Phone/Fax

Practice location:
  • Phone: 213-202-7580
  • Fax:
Mailing address:
  • Phone: 818-636-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: