Healthcare Provider Details

I. General information

NPI: 1194913897
Provider Name (Legal Business Name): INTERVENTIONAL VASCULAR INSTITUTE OF SAN JOSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

1130 TEN ROD RD D201
NORTH KINGSTOWN RI
02852-4161
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-0405
  • Fax:
Mailing address:
  • Phone: 877-591-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG74857
License Number StateCA

VIII. Authorized Official

Name: DR. ARASH M PADIDAR
Title or Position: CEO
Credential: MD
Phone: 408-918-0405