Healthcare Provider Details

I. General information

NPI: 1346646619
Provider Name (Legal Business Name): VASCULAR ACCESS CENTER OF SOUTH LOS ANGELES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE SUITE 301
DOWNEY CA
90241-5026
US

IV. Provider business mailing address

2929 ARCH STREET SUITE 1705
PHILADELPHIA PA
19104-2866
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-4027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MCGUCKIN
Title or Position: CEO
Credential:
Phone: 215-382-3680