Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 4301112455 | MI |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A163268 | CA |
NPI | 1154680981 |
---|---|
Provider Name | Raffi A Kotoyan |
First Address | Northridge, CA 91325-4148 |
Second Address | Northridge, CA 91325-4148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2012 |
Last Update Date | 11/02/2020 |