Provider Demographics
NPI:1023277126
Name:PETROSIAN, ROSA (COLLEGE)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:PETROSIAN
Suffix:
Gender:F
Credentials:COLLEGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 DEAUVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2828
Mailing Address - Country:US
Mailing Address - Phone:559-325-2052
Mailing Address - Fax:559-297-7190
Practice Address - Street 1:2471 DEAUVILLE CIR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-2828
Practice Address - Country:US
Practice Address - Phone:559-325-2052
Practice Address - Fax:559-297-7190
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB3580386343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)