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General NPI Number Information
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NPI Number | 1841298775
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Entity Type | Organization
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Legal Business Name | MARIA I. SELIVERSTOV, MD INC.
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 4835 VAN NUYS BLVD #104
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-986-9232
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Fax | 818-986-9716
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Provider Business Mailing Address
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Address Line | 4835 VAN NUYS BLVD #104
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-986-9232
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Fax | 818-986-9716
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Authorized Official
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Title or Position | CEO
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Name | MARIA I. SELIVERSTOV
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Credential | MD
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Telephone | 818-986-9232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | A066938
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | A066938
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License Number State | CA
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