Provider Demographics
NPI:1922242056
Name:ISAAC VIELMA MD, INC.
Entity Type:Organization
Organization Name:ISAAC VIELMA MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:VIELMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-920-8070
Mailing Address - Street 1:928 N SAN FERNANDO BLVD
Mailing Address - Street 2:#J-234
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4350
Mailing Address - Country:US
Mailing Address - Phone:818-920-8070
Mailing Address - Fax:818-245-1707
Practice Address - Street 1:928 N SAN FERNANDO BLVD
Practice Address - Street 2:#J-234
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4350
Practice Address - Country:US
Practice Address - Phone:818-920-8070
Practice Address - Fax:818-245-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90584207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty