Healthcare Provider Details

I. General information

NPI: 1487363321
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA VEIN & WOUND CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 WESTMINSTER AVE STE 211
GARDEN GROVE CA
92844-2751
US

IV. Provider business mailing address

9191 WESTMINSTER AVE STE 205
GARDEN GROVE CA
92844-2751
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-2000
  • Fax: 714-899-0051
Mailing address:
  • Phone: 714-899-2000
  • Fax: 714-899-0051

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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY QUACH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 714-799-5058