Healthcare Provider Details

I. General information

NPI: 1720500317
Provider Name (Legal Business Name): PASADENA VASCULAR DIRECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 VISTA RD STE 109
PASADENA TX
77504-2117
US

IV. Provider business mailing address

4301 VISTA RD STE 109
PASADENA TX
77504-2117
US

V. Phone/Fax

Practice location:
  • Phone: 281-416-5216
  • Fax:
Mailing address:
  • Phone: 281-416-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANEL MONROE
Title or Position: MANAGER
Credential:
Phone: 281-416-5216