Healthcare Provider Details

I. General information

NPI: 1033743240
Provider Name (Legal Business Name): VASCULAR INSTITUTE OF CLEVELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 ROCKSIDE RD STE 102
GARFIELD HEIGHTS OH
44125-4571
US

IV. Provider business mailing address

18375 VENTURA BLVD STE 554
TARZANA CA
91356-4218
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-0692
  • Fax: 805-790-0010
Mailing address:
  • Phone: 216-839-0692
  • Fax: 805-790-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA ARREDONDO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 216-839-0692