Healthcare Provider Details

I. General information

NPI: 1538871686
Provider Name (Legal Business Name): VASCULAR SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 615E
LOS ANGELES CA
90048-5910
US

IV. Provider business mailing address

8631 W 3RD ST STE 615E
LOS ANGELES CA
90048-5910
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-8132
  • Fax:
Mailing address:
  • Phone: 310-652-8132
  • 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: RAMEEN MORIDZADEH
Title or Position: PARTNER
Credential: MD
Phone: 310-600-1920