Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 136810 | CA |
Y | 208800000X | Urologist | A136810 | CA |
NPI | 1003136565 |
---|---|
Provider Name | Albert A Petrossian |
First Address | Long Beach, CA 90815-1454 |
Second Address | Long Beach, CA 90815-1454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2010 |
Last Update Date | 24/07/2017 |