Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A90584 | CA |
NPI | 1831284207 |
---|---|
Provider Name | Dr. Isaac Vielma |
First Address | Burbank, CA 91504-4350 |
Second Address | Reseda, CA 91335-6445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2580338 | (05) | CA |