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General NPI Number Information
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NPI Number | 1477780229
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Entity Type | Organization
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Legal Business Name | AVIISHA MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 415 ROLLING OAKS DR SUITE 210
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1029
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Country | US
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Telephone | 323-857-1682
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 W OLYMPIC BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90036-4667
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Country | US
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Telephone | 323-954-1788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABRAHAM ISHAAYA
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Credential | M.D.
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Telephone | 323-954-1788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 859439
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | G71854
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | G71854
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | G71854
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G71854
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License Number State | CA
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