1033660881 NPI number — SOUTHERN CALIFORNIA VEIN & ARTERY SPECIALISTS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033660881 NPI number — SOUTHERN CALIFORNIA VEIN & ARTERY SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN CALIFORNIA VEIN & ARTERY SPECIALISTS INC
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:
Provider Other Organization Name Type Code:
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:
1033660881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 CAMDEN AVE
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-8010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15031 RINALDI ST
Provider Second Line Business Practice Location Address:
MEDICAL STAFF ADMINISTRATION
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-991-7266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
EGHBALIEH
Authorized Official First Name:
SAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
VASCULAR SURGEON
Authorized Official Telephone Number:
818-900-6480

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  A133688 , 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)





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