Organization
MARIA I. SELIVERSTOV, MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA I. SELIVERSTOV MD (CEO)
(818) 986-9232
Entity
Organization
Contact information
Practice address
4835 VAN NUYS BLVD, #104, SHERMAN OAKS, CA 91403
(818) 986-9232
(818) 986-9716
Mailing address
4835 VAN NUYS BLVD, #104, SHERMAN OAKS, CA 91403
(818) 986-9232
(818) 986-9716
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
A066938
CA
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
A066938
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A669380
—
CA
Enumeration date
07/13/2005
Last updated
11/06/2007
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