MEDICARE: ISAAC VIELMA MD, 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	A90584	CA

General Provider Information

NPI Number	:	1922242056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISAAC VIELMA MD, INC.

Provider Business Mailing Address
First Line	:	928 N SAN FERNANDO BLVD
Second Line	:	#J-234
City	:	BURBANK
State	:	CA
Zip	:	91504-4350
Country	:	US
Telephone Number	:	818-920-8070
Fax Number	:	818-245-1707

Provider Business Practice Location Address
First Line	:	928 N SAN FERNANDO BLVD
Second Line	:	#J-234
City	:	BURBANK
State	:	CA
Zip	:	91504-4350
Country	:	US
Telephone Number	:	818-920-8070
Fax Number	:	818-245-1707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ISAAC VIELMA
Credential	:	MD
Telephone Number	:	818-920-8070

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	10/07/2010

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