Provider Demographics
NPI:1114681210
Name:PETROSYAN, KARAPET
Entity Type:Individual
Prefix:
First Name:KARAPET
Middle Name:
Last Name:PETROSYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2856
Mailing Address - Country:US
Mailing Address - Phone:818-601-1010
Mailing Address - Fax:
Practice Address - Street 1:643 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2856
Practice Address - Country:US
Practice Address - Phone:818-601-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1704755251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care