Healthcare Provider Details

I. General information

NPI: 1730983131
Provider Name (Legal Business Name): AUTHORITY VASCULAR SURGERY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W MARCH LN
STOCKTON CA
95207-6401
US

IV. Provider business mailing address

1611 W MARCH LN
STOCKTON CA
95207-6401
US

V. Phone/Fax

Practice location:
  • Phone: 209-645-2020
  • Fax: 209-227-1477
Mailing address:
  • Phone: 209-226-4300
  • Fax: 209-227-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL HERSCU
Title or Position: PRESIDENT
Credential: MD
Phone: 209-226-4300