Provider Demographics
NPI:1346541687
Name:VADIM LIPEL & ASSOCIATES, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VADIM LIPEL & ASSOCIATES, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-906-7643
Mailing Address - Street 1:2934 1/2 N BEVERLY GLEN CIR
Mailing Address - Street 2:#84
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1724
Mailing Address - Country:US
Mailing Address - Phone:818-906-7643
Mailing Address - Fax:818-906-7626
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-906-7643
Practice Address - Fax:818-906-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty