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General NPI Number Information
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NPI Number | 1245739820
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Entity Type | Organization
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Legal Business Name | NORTHRIDGE VASCULAR CENTER A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 19331 BUSINESS CENTER DR STE 102
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3533
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Country | US
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Telephone | 818-709-5555
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Fax | 818-739-1465
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Provider Business Mailing Address
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Address Line | 10605 BALBOA BLVD STE 240
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City | GRANADA HILLS
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State | CA
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Zip | 91344
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Country | US
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Telephone | 424-241-7160
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VINOD ASSOMULL
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Credential | MD
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Telephone | 424-241-7160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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