Provider Demographics
NPI:1831608165
Name:PATTERSON, TALLIN MARTIROSSIAN
Entity type:Individual
Prefix:
First Name:TALLIN
Middle Name:MARTIROSSIAN
Last Name:PATTERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12272 WILLOWBEND LN
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-5150
Mailing Address - Country:US
Mailing Address - Phone:626-708-0496
Mailing Address - Fax:626-714-2060
Practice Address - Street 1:101 S 1ST ST STE 305
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1961
Practice Address - Country:US
Practice Address - Phone:626-708-0496
Practice Address - Fax:626-714-2060
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6978207Q00000X, 363A00000X
CA55145207R00000X, 363A00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant