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General NPI Number Information
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NPI Number | 1679973366
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Entity Type | Organization
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Legal Business Name | ANDRE PANOSSIAN MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 09/29/2019
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Provider Practice Location Address
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Address Line | 39 CONGRESS ST STE 402
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City | PASADENA
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State | CA
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Zip | 91105-3024
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Country | US
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Telephone | 800-958-3778
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Fax | 800-958-3778
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Provider Business Mailing Address
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Address Line | 39 CONGRESS ST STE 402
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City | PASADENA
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State | CA
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Zip | 91105-3024
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Country | US
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Telephone | 800-958-3778
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Fax | 800-958-3778
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE PANOSSIAN
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Credential | MD
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Telephone | 800-958-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A76052
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License Number State | CA
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