MEDICARE: DR. DAVID MICHAEL VESCO 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	207QA0505X	Adult Medicine Physician	A43384	CA

General Provider Information

NPI Number	:	1629084074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL VESCO M.D

Provider Business Mailing Address
First Line	:	4937 LAS VIRGENES RD STE 104
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-2949
Country	:	US
Telephone Number	:	818-880-0799
Fax Number	:	818-880-6689

Provider Business Practice Location Address
First Line	:	4937 LAS VIRGENES RD STE 104
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-2949
Country	:	US
Telephone Number	:	818-880-0799
Fax Number	:	818-880-6689

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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