Healthcare Provider Details

I. General information

NPI: 1154485696
Provider Name (Legal Business Name): VADIM LIPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD SUITE 309
ENCINO CA
91436-2203
US

IV. Provider business mailing address

16260 VENTURA BLVD SUITE 309
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-7643
  • Fax: 818-906-7641
Mailing address:
  • Phone: 818-906-7643
  • Fax: 818-906-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA063487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: