Provider Demographics
NPI:1366545733
Name:AIZIN, VITALI (MD)
Entity type:Individual
Prefix:DR
First Name:VITALI
Middle Name:
Last Name:AIZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121619
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-6319
Mailing Address - Country:US
Mailing Address - Phone:619-823-0948
Mailing Address - Fax:
Practice Address - Street 1:321 E ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2667
Practice Address - Country:US
Practice Address - Phone:619-934-3260
Practice Address - Fax:619-934-3268
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA82761207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A827610Medicaid
CABV678AMedicare PIN