Healthcare Provider Details

I. General information

NPI: 1770107856
Provider Name (Legal Business Name): VASCULAR INSTITUTE OF HOUSTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 MAIN ST STE 100
HOUSTON TX
77030-4549
US

IV. Provider business mailing address

635 ANDERSON RD STE 4
DAVIS CA
95616-3505
US

V. Phone/Fax

Practice location:
  • Phone: 832-777-7570
  • Fax: 281-709-2575
Mailing address:
  • Phone: 832-777-7570
  • Fax: 281-709-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BONNIE POTTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 916-846-9454