Provider Demographics
NPI:1285173542
Name:CAROLINE C. PIESZAK M.D. INC.
Entity type:Organization
Organization Name:CAROLINE C. PIESZAK M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIESZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-777-7242
Mailing Address - Street 1:1220 LA VENTA DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3720
Mailing Address - Country:US
Mailing Address - Phone:805-777-7242
Mailing Address - Fax:805-777-7242
Practice Address - Street 1:1220 LA VENTA DR STE 105
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3720
Practice Address - Country:US
Practice Address - Phone:805-777-7242
Practice Address - Fax:805-777-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty