Healthcare Provider Details

I. General information

NPI: 1467652859
Provider Name (Legal Business Name): TRAUMA VASCULAR SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 VENTURA BLVD # 374
STUDIO CITY CA
91604-2406
US

IV. Provider business mailing address

12400 VENTURA BLVD # 374
STUDIO CITY CA
91604-2406
US

V. Phone/Fax

Practice location:
  • Phone: 818-445-8463
  • Fax: 866-428-9240
Mailing address:
  • Phone: 618-692-9640
  • Fax: 618-692-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA044434
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA044434
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA044434
License Number StateCA

VIII. Authorized Official

Name: DR. HILLARY A A CHOLLET
Title or Position: PRESIDENT
Credential: MD
Phone: 818-445-8463