Provider Demographics
NPI:1801087069
Name:VALERIE P ISRAEL D.O., INC
Entity type:Organization
Organization Name:VALERIE P ISRAEL D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:424-744-0077
Mailing Address - Street 1:5953 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-5224
Mailing Address - Country:US
Mailing Address - Phone:424-744-0077
Mailing Address - Fax:424-652-2233
Practice Address - Street 1:5953 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-5224
Practice Address - Country:US
Practice Address - Phone:424-744-0077
Practice Address - Fax:424-652-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A5886OtherLICENSE
CA00AX58860Medicaid
CAG05890OtherUPIN
CAG05890OtherUPIN
CA00AX58860Medicaid