Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | A106964 | CA |
NPI | 1467658914 |
---|---|
Provider Name | Dr. Gagik Oganesyan |
First Address | Santa Rosa, CA 95403-1671 |
Second Address | Santa Rosa, CA 95403-1671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/12/2021 |