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General NPI Number Information
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NPI Number | 1841473287
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Entity Type | Organization
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Legal Business Name | WILLIAM T VICARY J D M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 3575 CAHUENGA BLVD W SUITE 300
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City | LOS ANGELES
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State | CA
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Zip | 90068-1366
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Country | US
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Telephone | 323-876-9133
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Fax | 323-876-4716
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Provider Business Mailing Address
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Address Line | 3575 CAHUENGA BLVD W SUITE 300
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City | LOS ANGELES
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State | CA
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Zip | 90068-1366
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Country | US
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Telephone | 323-876-9133
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Fax | 323-876-4716
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM T VICARY
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Credential | M.D.
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Telephone | 323-876-9133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G30952
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License Number State | CA
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