Provider Demographics
NPI:1457543076
Name:PILOSSYAN MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PILOSSYAN MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAGHARSHAK
Authorized Official - Middle Name:MIKHAEL
Authorized Official - Last Name:PILOSSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-780-0101
Mailing Address - Street 1:13321 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1832
Mailing Address - Country:US
Mailing Address - Phone:818-780-0101
Mailing Address - Fax:818-780-8017
Practice Address - Street 1:13321 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1832
Practice Address - Country:US
Practice Address - Phone:818-780-0101
Practice Address - Fax:818-780-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A513031Medicaid
CA00A513031Medicaid