MEDICARE: CAROLINE C. PIESZAK M.D. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A64453	CA

General Provider Information

NPI Number	:	1285173542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINE C. PIESZAK M.D. INC.

Provider Business Mailing Address
First Line	:	1220 LA VENTA DR STE 105
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3720
Country	:	US
Telephone Number	:	805-777-7242
Fax Number	:	805-777-7242

Provider Business Practice Location Address
First Line	:	1220 LA VENTA DR STE 105
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3720
Country	:	US
Telephone Number	:	805-777-7242
Fax Number	:	805-777-7242

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CAROLINE C. PIESZAK
Credential	:	M.D.
Telephone Number	:	805-777-7242

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	02/20/2017

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