Healthcare Provider Details

I. General information

NPI: 1962013201
Provider Name (Legal Business Name): LPILOSSYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13321 VICTORY BLVD
VAN NUYS CA
91401-1832
US

IV. Provider business mailing address

13321 VICTORY BLVD
VAN NUYS CA
91401-1832
US

V. Phone/Fax

Practice location:
  • Phone: 818-517-6788
  • Fax:
Mailing address:
  • Phone: 818-793-1020
  • Fax: 865-935-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: LILIT PILOSSYAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 818-793-1020