Provider Demographics
NPI:1174664783
Name:POLOSAJIAN, LEO (MD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:POLOSAJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4930 BALBOA BLVD
Mailing Address - Street 2:NO 261278
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-7062
Mailing Address - Country:US
Mailing Address - Phone:818-718-1600
Mailing Address - Fax:818-718-1920
Practice Address - Street 1:7640 TAMPA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1713
Practice Address - Country:US
Practice Address - Phone:818-718-1600
Practice Address - Fax:818-343-1612
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81080207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease