Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 207YX0905X | CA |
NPI | 1558463216 |
---|---|
Provider Name | Raffi-Jean O Mesrobian |
First Address | Burbank, CA 91505-4402 |
Second Address | Burbank, CA 91505-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A88165 | (02) | CA |
C40119 | (05) | CA |