MEDICARE: CHRISTOPHER TOMASSIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	177939	CA
2	207N00000X	Dermatology Physician	177939	CA

General Provider Information

NPI Number	:	1871097550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER TOMASSIAN MD

Provider Business Mailing Address
First Line	:	552 W FOOTHILL BLVD STE 202
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-2470
Country	:	US
Telephone Number	:	626-240-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	552 W FOOTHILL BLVD STE 202
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-2470
Country	:	US
Telephone Number	:	818-795-8252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	08/24/2022

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