Healthcare Provider Details

I. General information

NPI: 1295332823
Provider Name (Legal Business Name): VNEO MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 1/2 KESTER AVE
VAN NUYS CA
91405-3716
US

IV. Provider business mailing address

6817 1/2 KESTER AVE
VAN NUYS CA
91405-3716
US

V. Phone/Fax

Practice location:
  • Phone: 818-483-4717
  • Fax: 818-483-4718
Mailing address:
  • Phone: 818-483-4717
  • Fax: 818-483-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENE OSTROVSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 818-483-4717