Individual
ANDRE PANOSSIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
01
—
00A760520
BLUE SHIELD #
CA
05
—
1710177845
—
CA
Enumeration date
07/25/2007
Last updated
09/15/2019
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