Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | CA65189 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | CA65189 | CA |
NPI | 1033401203 |
---|---|
Provider Name | Dr. Andrey Rossius |
First Address | Westlake Village, CA 91362-3606 |
Second Address | Westlake Village, CA 91362-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 16/12/2019 |