Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A66450 | CA |
NPI | 1255359964 |
---|---|
Provider Name | Dr. Vahe Panossian |
First Address | Pasadena, CA 91105-3023 |
Second Address | Pasadena, CA 91105-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |