Provider Demographics
NPI:1326103169
Name:MYSKO, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:MYSKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23928 LYONS AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2409
Mailing Address - Country:US
Mailing Address - Phone:661-254-6600
Mailing Address - Fax:661-254-1663
Practice Address - Street 1:23928 LYONS AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2409
Practice Address - Country:US
Practice Address - Phone:661-254-6600
Practice Address - Fax:661-254-1663
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G149390Medicaid
CAA39390Medicare UPIN
CAG14939Medicare ID - Type Unspecified