Provider Demographics
NPI:1467530121
Name:PILOSSYAN, VAGHARSHAK M (MD)
Entity Type:Individual
Prefix:DR
First Name:VAGHARSHAK
Middle Name:M
Last Name:PILOSSYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13321 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1832
Mailing Address - Country:US
Mailing Address - Phone:818-780-0101
Mailing Address - Fax:
Practice Address - Street 1:13321 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1832
Practice Address - Country:US
Practice Address - Phone:818-780-0101
Practice Address - Fax:818-780-8017
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51303207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A513031Medicaid
CAF67458Medicare UPIN
CA00A513031Medicaid