MEDICARE: DR. PANDIAN PAUL VIBOOSHANAN 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	208000000X	Pediatrics Physician	186395	NY
2	208000000X	Pediatrics Physician	C147787	CA

General Provider Information

NPI Number	:	1215992615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PANDIAN PAUL VIBOOSHANAN M.D.

Provider Business Mailing Address
First Line	:	385 SOUTH CATALINA AVE, APT 1125
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106
Country	:	US
Telephone Number	:	315-378-9578
Fax Number	:	315-464-2010

Provider Business Practice Location Address
First Line	:	8316 FOOD HILLS BLVD
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040
Country	:	US
Telephone Number	:	818-273-8925
Fax Number	:	818-844-5090

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	05/15/2019

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