Provider Demographics
NPI:1760480479
Name:SPYCHALSKI, JEFFREY WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WARD
Last Name:SPYCHALSKI
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 1:10994 EXPOSITION BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3140
Mailing Address - Country:US
Mailing Address - Phone:310-291-2813
Mailing Address - Fax:630-489-9658
Practice Address - Street 1:16311 VENTURA BLVD STE 1150
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4386
Practice Address - Country:US
Practice Address - Phone:818-477-0787
Practice Address - Fax:818-477-0677
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG70781CMedicare ID - Type Unspecified
CAF99475Medicare UPIN
CAWG70781AMedicare ID - Type Unspecified
CAWG70781DMedicare ID - Type Unspecified