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: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 S FAIR OAKS AVE STE 101
PASADENA CA
91105-2622
US

IV. Provider business mailing address

1044 S FAIR OAKS AVE STE 101
PASADENA CA
91105-2622
US

V. Phone/Fax

Practice location:
  • Phone: 310-291-8067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA125307
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD J VASAK
Title or Position: PRESIDENT
Credential: MD
Phone: 310-291-8067