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General NPI Number Information
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NPI Number | 1396467262
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Entity Type | Organization
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Legal Business Name | UPLAND VASCULAR CENTER LLC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 1317 W FOOTHILL BLVD STE 110
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City | UPLAND
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State | CA
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Zip | 91786-3675
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Country | US
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Telephone | 909-982-4040
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Fax | 909-982-4024
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Provider Business Mailing Address
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Address Line | 1317 W FOOTHILL BLVD STE 110
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City | UPLAND
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State | CA
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Zip | 91786-3675
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Country | US
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Telephone | 909-982-4040
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Fax | 909-982-4024
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARY PHUONG BUI
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Credential | DO
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Telephone | 909-982-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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