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General NPI Number Information
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NPI Number | 1245019454
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Entity Type | Organization
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Legal Business Name | LIPOV MEDICAL PC
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 15785 LAGUNA CANYON RD STE 125
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City | IRVINE
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State | CA
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Zip | 92618-3140
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Country | US
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Telephone | 937-838-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 15785 LAGUNA CANYON RD STE 125
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City | IRVINE
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State | CA
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Zip | 92618-3140
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Country | US
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Telephone | 937-838-0568
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MICHAEL GERSHENZON
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Credential |
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Telephone | 937-838-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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