Provider Demographics
NPI:1679554372
Name:CIZMAR, BRANISLAV (MD)
Entity Type:Individual
Prefix:
First Name:BRANISLAV
Middle Name:
Last Name:CIZMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 E VALLEY PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3363
Mailing Address - Country:US
Mailing Address - Phone:760-745-7060
Mailing Address - Fax:760-457-2596
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-745-7060
Practice Address - Fax:760-457-2596
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80606207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086660Medicaid
CAW14158OtherGROUP PTAN
CAW14158OtherGROUP PTAN
CAGR0086660Medicaid
W14697Medicare ID - Type Unspecified