Healthcare Provider Details

I. General information

NPI: 1124550355
Provider Name (Legal Business Name): RICHARD J. VASAK, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 S FAIR OAKS AVE
PASADENA CA
91105-2606
US

IV. Provider business mailing address

9716 PANTHER HOLLOW ST
LAS VEGAS NV
89141-8709
US

V. Phone/Fax

Practice location:
  • Phone: 626-737-0874
  • Fax: 702-974-0404
Mailing address:
  • Phone: 626-737-0874
  • Fax: 702-974-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA125307
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RICHARD J VASAK
Title or Position: PRESIDENT
Credential: MD
Phone: 626-397-5000