Healthcare Provider Details

I. General information

NPI: 1326609124
Provider Name (Legal Business Name): VASCULAR NEUROLOGY OF SOUTHERN CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD STE 125
THOUSAND OAKS CA
91360-1856
US

IV. Provider business mailing address

17525 VENTURA BLVD SUITE 210
ENCINO CA
91316-5109
US

V. Phone/Fax

Practice location:
  • Phone: 805-242-4884
  • Fax: 805-242-4885
Mailing address:
  • Phone: 818-986-2861
  • Fax: 818-638-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MUHAMMAD ASIF TAQI
Title or Position: OWNER
Credential: MD
Phone: 805-242-4884