Provider Demographics
NPI:1558463216
Name:MESROBIAN, RAFFI-JEAN O (MD)
Entity Type:Individual
Prefix:
First Name:RAFFI-JEAN
Middle Name:O
Last Name:MESROBIAN
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 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:307
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4402
Mailing Address - Country:US
Mailing Address - Phone:818-848-7345
Mailing Address - Fax:818-848-0685
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:818-848-7345
Practice Address - Fax:818-848-0685
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207YX0905X207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC40119Medicaid
CAC40119Medicaid
CAC40119AMedicare ID - Type Unspecified