MEDICARE: DR. VLAD NUSINOVICH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A92996	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A92996	OTHER	CA	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1144288036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLAD NUSINOVICH M.D.

Provider Business Mailing Address
First Line	:	7855 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5344
Country	:	US
Telephone Number	:	310-623-9222
Fax Number	:	310-921-5623

Provider Business Practice Location Address
First Line	:	7855 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5344
Country	:	US
Telephone Number	:	310-623-9222
Fax Number	:	310-921-5623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/06/2013

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