Provider Demographics
NPI:1477867257
Name:LYNNETTE TATOSYAN, DO INC
Entity Type:Organization
Organization Name:LYNNETTE TATOSYAN, DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-404-1897
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:315
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-404-1897
Mailing Address - Fax:
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:315
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-404-1897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8913207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty