Provider Demographics
NPI:1629084074
Name:VESCO, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:VESCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VESSELIN
Other - Middle Name:T
Other - Last Name:TCHALAKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4937 LAS VIRGENES RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2949
Mailing Address - Country:US
Mailing Address - Phone:818-880-0799
Mailing Address - Fax:818-880-6689
Practice Address - Street 1:4937 LAS VIRGENES RD STE 104
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2949
Practice Address - Country:US
Practice Address - Phone:818-880-0799
Practice Address - Fax:818-880-6689
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43384207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11585Medicare ID - Type Unspecified
CAE81803Medicare UPIN