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General NPI Number Information
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NPI Number | 1578514147
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Entity Type | Organization
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Legal Business Name | ISAAK VAYSBERG
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 18455 BURBANK BLVD STE.206
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City | TARZANA
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State | CA
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Zip | 91356-2803
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Country | US
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Telephone | 818-757-0975
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Fax | 818-757-0903
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Provider Business Mailing Address
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Address Line | 18455 BURBANK BLVD STE.206
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City | TARZANA
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State | CA
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Zip | 91356-2803
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Country | US
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Telephone | 818-757-0975
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Fax | 818-757-0903
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Authorized Official
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Title or Position | CEO
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Name | MR. ISAAK VAYSBERG
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Credential | ARDMS, RVT,RDCS
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Telephone | 818-681-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | TG195
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License Number State | CA
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