Organization
ANDRE PANOSSIAN MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE PANOSSIAN MD (OWNER)
(800) 958-3778
Entity
Organization
Contact information
Practice address
39 CONGRESS ST STE 402, PASADENA, CA 91105-3024
(800) 958-3778
(800) 958-3778
Mailing address
39 CONGRESS ST STE 402, PASADENA, CA 91105-3024
(800) 958-3778
(800) 958-3778
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
A76052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A760520
—
CA
Enumeration date
08/29/2014
Last updated
09/29/2019
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