Vitaley Kovalev, PA-C, DO is a medicare enrolled "Student In An Organized Health Care Education/training Program" in Los Angeles, California. His current practice location is
10100 S San Pedro St, Los Angeles, California. You can reach out to his office (for appointments etc.) via phone at
(323) 578-5451.
Vitaley Kovalev is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1750637740.
Provider's Profile
Full Name | Vitaley Kovalev |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 10100 S San Pedro St, Los Angeles, California |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1750637740
- Provider Enumeration Date: 07/27/2012
- Last Update Date: 04/26/2021
Medicare PECOS Information:
- PECOS PAC ID: 4284859901
- Enrollment ID: I20151016000363
Medical Identifiers
Medical identifiers for Vitaley Kovalev such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1750637740 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363AM0700X | Physician Assistant - Medical | 0010-03549 (North Carolina) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Vitaley Kovalev is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Vitaley Kovalev, PA-C, DO 10100 S San Pedro St, Los Angeles, CA 90003-4830 Ph: (323) 578-5451 | Vitaley Kovalev, PA-C, DO 10100 S San Pedro St, Los Angeles, CA 90003-4830 Ph: (323) 578-5451 |
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