Healthcare Provider Details

I. General information

NPI: 1538872767
Provider Name (Legal Business Name): VASCULAR INSTITUTE OF SOUTHERN CALIFORNIA INC, A PODIATRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N TUSTIN AVE STE 206
SANTA ANA CA
92705-3606
US

IV. Provider business mailing address

18375 VENTURA BLVD # 554
TARZANA CA
91356-4218
US

V. Phone/Fax

Practice location:
  • Phone: 714-694-4665
  • Fax:
Mailing address:
  • Phone: 714-694-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VLADIMIR ZEETSER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 818-259-1138