Healthcare Provider Details

I. General information

NPI: 1073200945
Provider Name (Legal Business Name): CALIFORNIA NEUROVASCULAR SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 7101211W
ANAHEIM CA
92801-2815
US

IV. Provider business mailing address

PO BOX 9
LAKEWOOD CA
90714-0009
US

V. Phone/Fax

Practice location:
  • Phone: 657-888-9199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RADOSLAV RAYCHEV
Title or Position: SECRETARY
Credential: MD
Phone: 415-290-8683