Healthcare Provider Details

I. General information

NPI: 1215213103
Provider Name (Legal Business Name): RICHARD JOHN VASAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
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: 626-397-5000
  • Fax:
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 NumberA125307
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA125307
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA125307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: