Healthcare Provider Details

I. General information

NPI: 1306218011
Provider Name (Legal Business Name): VASCULAR INTERVENTIONAL PARTNERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 S SUNSET AVE
WEST COVINA CA
91790-3408
US

IV. Provider business mailing address

18375 VENTURA BLVD # 554
TARZANA CA
91356-4218
US

V. Phone/Fax

Practice location:
  • Phone: 626-888-7814
  • Fax:
Mailing address:
  • Phone: 626-888-7814
  • Fax: 888-947-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK MORGAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 310-880-7442