Healthcare Provider Details

I. General information

NPI: 1821901471
Provider Name (Legal Business Name): SOCAL ADVANCED VASCULAR AND EMBOLIZATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15901 HAWTHORNE BLVD STE 105
LAWNDALE CA
90260-2657
US

IV. Provider business mailing address

15901 HAWTHORNE BLVD STE 105
LAWNDALE CA
90260-2657
US

V. Phone/Fax

Practice location:
  • Phone: 310-753-1449
  • Fax:
Mailing address:
  • Phone: 310-753-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINA MIGLAS
Title or Position: OWNER
Credential:
Phone: 310-753-1449