Healthcare Provider Details

I. General information

NPI: 1942326467
Provider Name (Legal Business Name): VILLA PATRIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N VALLEY ST SUITE 401
BURBANK CA
91505-3951
US

IV. Provider business mailing address

211 N VALLEY ST SUITE 401
BURBANK CA
91505-3951
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax:
Mailing address:
  • Phone: 916-678-6760
  • Fax: 916-678-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA34168
License Number StateCA

VIII. Authorized Official

Name: ZBIGNIEW DWORAK
Title or Position: CEO
Credential: M.D.
Phone: 818-823-8704