Healthcare Provider Details

I. General information

NPI: 1881930949
Provider Name (Legal Business Name): NORTH COUNTY VASCULAR CENTER A CA PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N ELM ST SUITE 204
ESCONDIDO CA
92025-3431
US

IV. Provider business mailing address

255 N ELM ST SUITE 204
ESCONDIDO CA
92025-3431
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-0870
  • Fax: 760-294-0871
Mailing address:
  • Phone: 760-294-0870
  • Fax: 760-294-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OSMAN KHAWAR
Title or Position: PRESIDENT
Credential: MD
Phone: 760-745-1551