Provider Demographics
NPI:1225068414
Name:SPIWAK, JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:SPIWAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2659
Mailing Address - Country:US
Mailing Address - Phone:562-698-0271
Mailing Address - Fax:562-698-7467
Practice Address - Street 1:3680 E IMPERIAL HWY
Practice Address - Street 2:SUITE 502
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2659
Practice Address - Country:US
Practice Address - Phone:562-698-0271
Practice Address - Fax:562-698-7467
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32316208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8687AOtherMEDICARE GROUP PROVIDER
CA00A323160Medicaid
CAW8687OtherMEDICARE GROUP PROVIDER
CAZZZ80580ZOtherMEDICAID GROUP PROVIDER
CAWA32316CMedicare PIN
CAZZZ80580ZOtherMEDICAID GROUP PROVIDER
CAW8687OtherMEDICARE GROUP PROVIDER