Healthcare Provider Details

I. General information

NPI: 1164933636
Provider Name (Legal Business Name): CENTER FOR ADVANCED VASCULAR INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18226 VENTURA BLVD STE 102
TARZANA CA
91356-4246
US

IV. Provider business mailing address

8635 W 3RD ST STE 695W
LOS ANGELES CA
90048-6162
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 818-905-5904
  • Fax: 310-967-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MEHRAN J KHORSANDI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-905-5904