Provider Demographics
NPI:1366449985
Name:ZEETSER, VLADIMIR (DPM)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:ZEETSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 BALBOA BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5226
Mailing Address - Country:US
Mailing Address - Phone:818-907-6100
Mailing Address - Fax:866-513-4995
Practice Address - Street 1:5400 BALBOA BLVD STE 325
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5226
Practice Address - Country:US
Practice Address - Phone:818-907-6100
Practice Address - Fax:866-513-4995
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4504213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45041Medicaid
CA5076980001OtherMEDICARE DMERC
CA000E45041Medicaid
CA5076980001OtherMEDICARE DMERC
CA5076980001Medicare NSC
CAWE4504AMedicare PIN