Healthcare Provider Details

I. General information

NPI: 1194100685
Provider Name (Legal Business Name): VASCULAR CENTER OF INTERVENTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E HERNDON AVE STE 102
FRESNO CA
93720-3164
US

IV. Provider business mailing address

1191 E HERNDON AVE STE 102
FRESNO CA
93720-3164
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-7337
  • Fax:
Mailing address:
  • Phone: 310-547-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG84634
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES LEE
Title or Position: OWNER
Credential:
Phone: 559-702-1390