1174624944 NPI number — MS VAISMAN MEDICAL SERVICES A PROFESSIONAL CORPORATION

Table of content: (NPI 1174624944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174624944 NPI number — MS VAISMAN MEDICAL SERVICES A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MS VAISMAN MEDICAL SERVICES A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174624944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11724 VENTURA BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-506-6937
Provider Business Mailing Address Fax Number:
818-506-2594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11724 VENTURA BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-506-6937
Provider Business Practice Location Address Fax Number:
818-506-2594
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAISMAN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
818-506-6937

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A38899 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: A38899 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278P1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 206140013 . This is a "PACIFICARE PREMIER HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2840525 . This is a "AETNA HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 146780057 . This is a "PACIFICARE NIPA HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 24013 . This is a "UHP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3709552008 . This is a "CIGNA PREMIER HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 146970061 . This is a "PACIFICARE ST VINCENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4341338 . This is a "AETNA PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 124100111 . This is a "PACIFICARE REGAL HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 19190 . This is a "CARE 1ST HEALTH PLAN NOBL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 3709552 . This is a "CIGNA PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A388990 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A388990 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047692 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DK033 . This is a "UNIVERSAL CARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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