Provider Demographics
NPI:1598787574
Name:HOUSE CALLS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HOUSE CALLS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:V
Authorized Official - Last Name:PERSIDSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-443-5959
Mailing Address - Street 1:5434 HERON BAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4821
Mailing Address - Country:US
Mailing Address - Phone:714-443-5959
Mailing Address - Fax:714-443-5763
Practice Address - Street 1:5434 HERON BAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4821
Practice Address - Country:US
Practice Address - Phone:714-443-5959
Practice Address - Fax:714-443-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2822348OtherCORPORATION NUMBER
CA1437188299OtherPERSIDSKY NPI NUMBER
CABU99035610OtherCITY BUSINESS LICENSE