Active NPI
Lara Petrossian
- Pharmacist
- Loma Linda, CA
National Provider Identifier
1336538438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S020987
- Practice address
- 11201 Benton St
Loma Linda, CA 92357-1000 - Phone
- (909) 825-7054
- NPI assigned
- Jan 13, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S020987 | AZ | Primary |
Addresses
Primary practice location
11201 Benton St
Loma Linda, CA 92357-1000
Mailing address
628 Marek Dr
Montebello, CA 90640-2637
Phone (323) 397-6990
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S020987 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1336538438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 MAREK DR",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906402637",
"telephone_number": "323-397-6990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11201 BENTON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923571000",
"telephone_number": "909-825-7054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROSSIAN",
"first_name": "LARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-13",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S020987",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.