Healthcare Provider Details

I. General information

NPI: 1952158370
Provider Name (Legal Business Name): NICOLAS VARDIABASIS, DO A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 MEDICAL CENTER DR STE 500
WEST HILLS CA
91307-4024
US

IV. Provider business mailing address

14332 VENTURA BLVD
SHERMAN OAKS CA
91423-2717
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLAS VARDIABASIS
Title or Position: PRESIDENT
Credential: DO
Phone: 562-547-5319