Healthcare Provider Details

I. General information

NPI: 1588317499
Provider Name (Legal Business Name): PETROSYAN ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 STEARNS ST STE B
SIMI VALLEY CA
93063-2418
US

IV. Provider business mailing address

2428 STEARNS ST STE B
SIMI VALLEY CA
93063-2418
US

V. Phone/Fax

Practice location:
  • Phone: 805-422-8090
  • Fax: 805-422-8141
Mailing address:
  • Phone: 805-422-8090
  • Fax: 805-422-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HAIK PETROSYAN
Title or Position: OWNER
Credential:
Phone: 805-422-8090