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General NPI Number Information
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NPI Number | 1598911497
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Entity Type | Organization
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Legal Business Name | BORIS VAISMAN MEDICAL COPORATION
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 22600 VENTURA BLVD STE 101
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1430
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Country | US
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Telephone | 818-225-1255
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Fax | 818-225-8646
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Provider Business Mailing Address
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Address Line | 4932 CHIMINEAS AVE
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City | TARZANA
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State | CA
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Zip | 91356-4302
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Country | US
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Telephone | 818-225-1255
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Fax | 818-225-8646
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Authorized Official
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Title or Position | CEO
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Name | DR. BORIS VAISMAN
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Credential | M.D.
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Telephone | 818-225-1255
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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 | A92266
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License Number State | CA
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