Healthcare Provider Details

I. General information

NPI: 1487070553
Provider Name (Legal Business Name): ROGER VERTREES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 KNOWLES DRIVE STE 203
LOS GATOS CA
95032-1551
US

IV. Provider business mailing address

555 KNOWLES DRIVE STE 203
LOS GATOS CA
95032-1551
US

V. Phone/Fax

Practice location:
  • Phone: 408-827-4274
  • Fax: 408-358-8692
Mailing address:
  • Phone: 408-827-4274
  • Fax: 408-358-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: