Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A69455 | CA |
NPI | 1013070929 |
---|---|
Provider Name | Maryetta Ovsepian |
First Address | Sun Valley, CA 91352 |
Second Address | Sylmar, CA 91342-1495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 03/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H50633 | (02) |