Provider Demographics
NPI:1003023821
Name:ROBERE J. MISSIRIAN MD INC
Entity Type:Organization
Organization Name:ROBERE J. MISSIRIAN MD INC
Other - Org Name:MOMG/MISSIRIAN ORTHOPAEDIC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MISSIRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-759-2555
Mailing Address - Street 1:13029A VICTORY BLVD # 525
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2925
Mailing Address - Country:US
Mailing Address - Phone:818-759-2555
Mailing Address - Fax:
Practice Address - Street 1:6801 COLDWATER CANYON AVE STE 1E
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5167
Practice Address - Country:US
Practice Address - Phone:818-759-2555
Practice Address - Fax:818-759-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty