Provider Demographics
NPI:1679919898
Name:TOSSONIAN, PAUL AGHWRD
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AGHWRD
Last Name:TOSSONIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22600 SAVI RANCH PKWY STE A42
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4606
Mailing Address - Country:US
Mailing Address - Phone:800-714-8117
Mailing Address - Fax:714-701-6168
Practice Address - Street 1:22600 SAVI RANCH PARKWAY SUITE A42
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-4619
Practice Address - Country:US
Practice Address - Phone:800-714-8117
Practice Address - Fax:714-701-6168
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB9515859172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver