1407036288 NPI number — VASCULAR AND ENDOVASCULAR INSTITUTE OF ORANGE COUNTY, A MEDICAL CORPOR

Table of content: (NPI 1407036288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407036288 NPI number — VASCULAR AND ENDOVASCULAR INSTITUTE OF ORANGE COUNTY, A MEDICAL CORPOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR AND ENDOVASCULAR INSTITUTE OF ORANGE COUNTY, A MEDICAL CORPOR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GARABED PARUNAG 'GARY' NISHANIAN MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407036288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16100 SAND CANYON AVE
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-3716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-429-8840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16100 SAND CANYON AVE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-429-8840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NISHANIAN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-429-8840

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  A52537 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A525370 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".