| Boris Vaisman Medical Coporation | |
|
22600 Ventura Blvd Ste 101 Woodland Hills CA 91364-1430 | |
| (818) 225-1255 | |
| (818) 225-8646 |
| Full Name | Boris Vaisman Medical Coporation |
|---|---|
| Speciality | Family Medicine |
| Location | 22600 Ventura Blvd Ste 101, Woodland Hills, California |
| Authorized Official Name and Position | Boris Vaisman (CEO) |
| Authorized Official Contact | 8182251255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boris Vaisman Medical Coporation 4932 Chimineas Ave Tarzana CA 91356-4302 Ph: (818) 225-1255 | Boris Vaisman Medical Coporation 22600 Ventura Blvd Ste 101 Woodland Hills CA 91364-1430 Ph: (818) 225-1255 |
| NPI Number | 1598911497 |
|---|---|
| Provider Enumeration Date | 08/11/2008 |
| Last Update Date | 08/11/2008 |
| Medicare PECOS PAC ID | 6002001328 |
|---|---|
| Medicare Enrollment ID | O20101112000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598911497 | NPI | - | NPPES |
| 2901737 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A92266 (California) | Primary |
| Provider Name | Boris Vaisman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508801994 PECOS PAC ID: 3072709872 Enrollment ID: I20101118001116 |
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