Provider Demographics
NPI:1437922333
Name:BABAYAN, SOSEH
Entity Type:Individual
Prefix:
First Name:SOSEH
Middle Name:
Last Name:BABAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1605
Mailing Address - Country:US
Mailing Address - Phone:818-423-7722
Mailing Address - Fax:
Practice Address - Street 1:2048 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1605
Practice Address - Country:US
Practice Address - Phone:818-957-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily