Provider Demographics
NPI:1437341518
Name:NORBERTO S. WAISMAN MD. INC.
Entity Type:Organization
Organization Name:NORBERTO S. WAISMAN MD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-426-5252
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-426-5252
Mailing Address - Fax:619-426-1918
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-426-5252
Practice Address - Fax:619-426-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35479207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A354790Medicaid
CA1407962491OtherNPI
CAW18783Medicare PIN