Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A91822 | CA |
NPI | 1013117605 |
---|---|
Provider Name | Dr. Vladimir Nossov |
First Address | Los Angeles, CA 90046-6845 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 20/07/2007 |