Healthcare Provider Details

I. General information

NPI: 1417720517
Provider Name (Legal Business Name): COMPREHENSIVE VASCULAR INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 300
LONG BEACH CA
90806-2776
US

IV. Provider business mailing address

16 QUARTERDECK ST UNIT 102
MARINA DEL REY CA
90292-6759
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-2900
  • Fax:
Mailing address:
  • Phone: 310-869-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHNATHON CURTIS ROLLO
Title or Position: PRESIDENT
Credential: MD
Phone: 310-869-2900