Provider Demographics
NPI:1982625893
Name:ANNA MARIA VEYTSMAN MDSC
Entity Type:Organization
Organization Name:ANNA MARIA VEYTSMAN MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEYTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-460-4717
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:210 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3807
Practice Address - Country:US
Practice Address - Phone:714-347-1010
Practice Address - Fax:714-647-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31498300Medicaid
WIF08019Medicare UPIN
WI000101895Medicare PIN
WI31498300Medicaid