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General NPI Number Information
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NPI Number | 1124550355
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Entity Type | Organization
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Legal Business Name | RICHARD J. VASAK, M.D., INC.
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 1044 S FAIR OAKS AVE STE 101
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City | PASADENA
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State | CA
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Zip | 91105-2622
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Country | US
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Telephone | 310-291-8067
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 S FAIR OAKS AVE STE 101
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City | PASADENA
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State | CA
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Zip | 91105-2622
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD J VASAK
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Credential | MD
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Telephone | 310-291-8067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | A125307
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License Number State | CA
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