Healthcare Provider Details

I. General information

NPI: 1982964805
Provider Name (Legal Business Name): VASCULAR IMAGING PROFESSIONALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N DYNAMICS ST SUITE A
ANAHEIM CA
92806-1902
US

IV. Provider business mailing address

1340 N DYNAMICS ST SUITE A
ANAHEIM CA
92806-1902
US

V. Phone/Fax

Practice location:
  • Phone: 877-484-7462
  • Fax: 888-847-6110
Mailing address:
  • Phone: 877-484-7462
  • Fax: 888-847-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATT LIEBERMAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 877-484-7462