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General NPI Number Information
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NPI Number | 1417222860
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Entity Type | Organization
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Legal Business Name | SAN GABRIEL VALLEY VASCULAR INSTITUTE
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 506 W VALLEY BLVD SUITE 300
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City | SAN GABRIEL
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State | CA
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Zip | 91776-3731
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Country | US
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Telephone | 213-977-7418
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILSHIRE BLVD SUITE 101
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City | LOS ANGELES
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State | CA
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Zip | 90017-1916
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Country | US
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Telephone | 213-223-1100
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Fax | 213-223-1104
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GAIL L BREWER
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Credential |
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Telephone | 213-223-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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