Healthcare Provider Details

I. General information

NPI: 1558529545
Provider Name (Legal Business Name): OLGA VOROSHILOVSKY, M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE #750-W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST SUITE #750-W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8700
  • Fax: 310-659-1369
Mailing address:
  • Phone: 310-659-8700
  • Fax: 310-659-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA81570
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA81570
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA81570
License Number StateCA

VIII. Authorized Official

Name: DR. OLGA VOROSHILOVSKY
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 310-625-3065