1972181493 NPI number — VASCULAR CARE SPECIALISTS OF LOS ANGELES

Table of content: (NPI 1972181493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972181493 NPI number — VASCULAR CARE SPECIALISTS OF LOS ANGELES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR CARE SPECIALISTS OF LOS ANGELES
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:
1972181493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 S LAKE AVE # 867
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101-3515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-269-9993
Provider Business Mailing Address Fax Number:
626-269-9994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 W DUARTE RD STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91007-9231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-275-9566
Provider Business Practice Location Address Fax Number:
626-387-4188
Provider Enumeration Date:
03/29/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
626-275-9566

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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