| Canyon Medical Center Corporation | |
|
4937 Las Virgenes Rd Suite 104 Calabasas CA 91302-2949 | |
| (818) 880-0799 | |
| (818) 880-6689 |
| Full Name | Canyon Medical Center Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 4937 Las Virgenes Rd, Calabasas, California |
| Authorized Official Name and Position | David Vesco (OWNER) |
| Authorized Official Contact | 8188800799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Medical Center Corporation 4937 Las Virgenes Rd Suite 104 Calabasas CA 91302-2949 Ph: (818) 880-0799 | Canyon Medical Center Corporation 4937 Las Virgenes Rd Suite 104 Calabasas CA 91302-2949 Ph: (818) 880-0799 |
| NPI Number | 1164679718 |
|---|---|
| Provider Enumeration Date | 08/26/2008 |
| Last Update Date | 11/14/2014 |
| Medicare PECOS PAC ID | 2466582689 |
|---|---|
| Medicare Enrollment ID | O20100615000756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164679718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | 43384A (California) | Primary |
| Provider Name | David Md Vesco |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629084074 PECOS PAC ID: 0244361871 Enrollment ID: I20100626000071 |
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