Healthcare Provider Details

I. General information

NPI: 1215934336
Provider Name (Legal Business Name): RICHARD W. VANIS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR STE 617
ARCADIA CA
91007-1518
US

IV. Provider business mailing address

301 W HUNTINGTON DR STE 617
ARCADIA CA
91007-1518
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-9745
  • Fax: 626-574-8741
Mailing address:
  • Phone: 626-574-9745
  • Fax: 626-574-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG34782
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD WILLIAM VANIS
Title or Position: ORTHOPEDIC SURGEON
Credential: M.D.
Phone: 626-574-9745