# LEO POLOSAJIAN MD A PROFESSIONAL MED CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912122631
- **Authorized official:** LEO POLOSAJIAN MD (CEO)
- **Authorized official phone:** (818) 718-1600

## Contact information

- **Practice address:** 7640 TAMPA AVE STE 101, RESEDA, CA 91335-1713
- **Practice address phone:** (818) 718-1600
- **Practice address fax:** (818) 718-1920
- **Mailing address:** 4930 BALBOA BLVD UNIT 261278, ENCINO, CA 91426-7062
- **Mailing address phone:** (818) 718-1600
- **Mailing address fax:** (818) 718-1920

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | NULL | Yes |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2007
- **Last updated:** 06/19/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1174664783 | PERSONAL NPI NUMBER | CA |
| 01 | — | A81080 | CA LICENSE NUMBER | CA |