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General NPI Number Information
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NPI Number | 1285173542
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Entity Type | Organization
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Legal Business Name | CAROLINE C. PIESZAK M.D. INC.
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1220 LA VENTA DR STE 105
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3720
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Country | US
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Telephone | 805-777-7242
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Fax | 805-777-7242
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Provider Business Mailing Address
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Address Line | 1220 LA VENTA DR STE 105
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3720
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Country | US
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Telephone | 805-777-7242
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Fax | 805-777-7242
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROLINE C. PIESZAK
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Credential | M.D.
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Telephone | 805-777-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A64453
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License Number State | CA
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