Healthcare Provider Details

I. General information

NPI: 1174624944
Provider Name (Legal Business Name): MS VAISMAN MEDICAL SERVICES A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11724 VENTURA BLVD SUITE A
STUDIO CITY CA
91604
US

IV. Provider business mailing address

11724 VENTURA BLVD SUITE A
STUDIO CITY CA
91604
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-6937
  • Fax: 818-506-2594
Mailing address:
  • Phone: 818-506-6937
  • Fax: 818-506-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA38899
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA38899
License Number StateCA

VIII. Authorized Official

Name: DR. MARK VAISMAN
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 818-506-6937