Provider Demographics
NPI:1609209436
Name:PETROSYAN, HEGENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEGENE
Middle Name:
Last Name:PETROSYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8054 VARNA AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6406
Mailing Address - Country:US
Mailing Address - Phone:818-929-4503
Mailing Address - Fax:
Practice Address - Street 1:8054 VARNA AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6406
Practice Address - Country:US
Practice Address - Phone:818-929-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814452163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse