1629512595 NPI number — AHI VEIN AND VASCULAR SPECIALISTS INC A PROFESSIONAL MEDICAL CORPORATI

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 1629512595 NPI number — AHI VEIN AND VASCULAR SPECIALISTS INC A PROFESSIONAL MEDICAL CORPORATI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHI VEIN AND VASCULAR SPECIALISTS INC A PROFESSIONAL MEDICAL CORPORATI
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:
OCEANA VEIN SPECIALISTS
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:
1629512595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6247 LA JOLLA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037
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:
2125 SOUTH EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-307-5315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ISADORE
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-307-5315

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  C3894822 , 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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