Healthcare Provider Details

I. General information

NPI: 1730361163
Provider Name (Legal Business Name): EXPERIENCED VASCULAR IMAGING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23135 MARKET ST
NEWHALL CA
91321-3611
US

IV. Provider business mailing address

23135 MARKET ST
NEWHALL CA
91321-3611
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-6243
  • Fax: 661-254-8532
Mailing address:
  • Phone: 661-254-6243
  • Fax: 661-254-8532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: BARBARA HUERTA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 661-254-6243