Serge Petrosian, CADC II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

A7121111 Issued in CA

Practice address

5930 S Main St
Suite 104
Los Angeles, CA 90003-1201

Phone

(818) 551-0026

NPI assigned

Feb 14, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• California Care Corp.

  • Health Maintenance Organization
  • Los Angeles, CA
  • NPI 1114291580
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329177600000",
    "number": "1124391669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 E ELMWOOD AVE",
            "address_2": "APT. O",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915012587",
            "telephone_number": "818-804-6520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5930 S MAIN ST",
            "address_2": "SUITE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900031201",
            "telephone_number": "818-551-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSIAN",
        "first_name": "SERGE",
        "credential": "CADC II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-14",
        "last_updated": "2012-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "A7121111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrey Petrikovets, M.D.
• Gwenn Petrillo
• Orest V Petrishen, N.D., PH.D., C.N.C.
• Katherine Frances Petroka, MS, RD
• Narine Petrosian, DDS
• Solange Petrosspour
• Brittni Nicole Petrosy
• Ana Petrosyan
• Edgar Petrosyan
• Hakop Jack Petrosyan, PT, DPT

• Addiction (Substance Use Disorder) Counselor in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.