Provider Demographics
NPI:1336328301
Name:ANTHONY VIRELLA MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANTHONY VIRELLA MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-817-9832
Mailing Address - Street 1:1250 LA VENTA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3702
Mailing Address - Country:US
Mailing Address - Phone:805-449-0088
Mailing Address - Fax:805-449-0046
Practice Address - Street 1:1250 LA VENTA DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3702
Practice Address - Country:US
Practice Address - Phone:805-449-0088
Practice Address - Fax:805-449-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72225207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI00055Medicare UPIN
CAA72225Medicare PIN