MEDICARE: HOUSE CALLS MEDICAL CORPORATION

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	207R00000X	Internal Medicine Physician	A54121	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2822348	OTHER	CA	CORPORATION NUMBER
2	1437188299	OTHER	CA	PERSIDSKY NPI NUMBER
3	BU99035610	OTHER	CA	CITY BUSINESS LICENSE

General Provider Information

NPI Number	:	1598787574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSE CALLS MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	5434 HERON BAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4821
Country	:	US
Telephone Number	:	714-443-5959
Fax Number	:	714-443-5763

Provider Business Practice Location Address
First Line	:	5434 HERON BAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4821
Country	:	US
Telephone Number	:	714-443-5959
Fax Number	:	714-443-5763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IGOR V PERSIDSKY
Credential	:	MD
Telephone Number	:	714-443-5959

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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Directions to “HOUSE CALLS MEDICAL CORPORATION ” Practice Location

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