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General NPI Number Information
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NPI Number | 1801045778
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Entity Type | Organization
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Legal Business Name | L.E.V. MEDICAL GROUP, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 7855 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-5344
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Country | US
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Telephone | 310-623-9222
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Fax | 310-921-5623
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Provider Business Mailing Address
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Address Line | 7855 SANTA MONICA BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-5344
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Country | US
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Telephone | 310-623-9222
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Fax | 310-921-5623
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VLAD NUSINOVICH
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Credential | MD
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Telephone | 310-623-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A92996
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License Number State | CA
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