Provider Demographics
NPI:1326768573
Name:PETROSYAN, SYUZANNA (LVN)
Entity Type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:PETROSYAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20742 BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2407
Mailing Address - Country:US
Mailing Address - Phone:747-999-8811
Mailing Address - Fax:
Practice Address - Street 1:20742 BLACKHAWK ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2407
Practice Address - Country:US
Practice Address - Phone:747-999-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA708718164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty