Healthcare Provider Details

I. General information

NPI: 1912937814
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA VASCULAR ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 406
ORANGE CA
92868-3855
US

IV. Provider business mailing address

1310 W STEWART DR STE 406
ORANGE CA
92868-3855
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-0793
  • Fax: 714-516-1932
Mailing address:
  • Phone: 714-532-0793
  • Fax: 714-780-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2410301
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM J. FOLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-532-0793