Provider Demographics
NPI:1407097447
Name:VITALI AIZIN, M.D. INC.
Entity Type:Organization
Organization Name:VITALI AIZIN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VITALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AIZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-823-0948
Mailing Address - Street 1:PO BOX 121619
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-6319
Mailing Address - Country:US
Mailing Address - Phone:619-427-8646
Mailing Address - Fax:
Practice Address - Street 1:321 E ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2667
Practice Address - Country:US
Practice Address - Phone:619-823-0948
Practice Address - Fax:619-370-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-22
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407097447Medicaid
CABV678AMedicare PIN
CA1407097447Medicaid