Healthcare Provider Details

I. General information

NPI: 1659402311
Provider Name (Legal Business Name): OLGA VOROSHILOVSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 750W
WEST HOLLYWOOD CA
90048-6101
US

IV. Provider business mailing address

11938 GOSHEN AVE #5
LOS ANGELES CA
90049-6320
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8700
  • Fax:
Mailing address:
  • Phone: 310-231-3492
  • Fax:

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:
Title or Position:
Credential:
Phone: