Provider Demographics
NPI:1801200613
Name:BUCH, VISHAAL
Entity Type:Individual
Prefix:
First Name:VISHAAL
Middle Name:
Last Name:BUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 MOTT ST # 100-110
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4237
Mailing Address - Country:US
Mailing Address - Phone:818-963-5690
Mailing Address - Fax:
Practice Address - Street 1:732 MOTT ST # 100-110
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4237
Practice Address - Country:US
Practice Address - Phone:818-963-5690
Practice Address - Fax:818-365-0726
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine