Healthcare Provider Details

I. General information

NPI: 1518972967
Provider Name (Legal Business Name): VLADIMIR ZEETSER, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 325
ENCINO CA
91316-5226
US

IV. Provider business mailing address

5400 BALBOA BLVD STE 325
ENCINO CA
91316-5226
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-6100
  • Fax: 866-513-4995
Mailing address:
  • Phone: 818-907-6100
  • Fax: 866-513-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4504
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5418910001
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5418910001
License Number StateCA

VIII. Authorized Official

Name: VLADIMIR ZEETSER
Title or Position: PRESIDENT
Credential: DPM
Phone: 818-907-6100