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General NPI Number Information
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NPI Number | 1477905388
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Entity Type | Organization
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Legal Business Name | VANGUARD SPECIALTY IMAGING
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 1345 LILLIAN AVE
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City | SUNNYVALE
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State | CA
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Zip | 94087-3523
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Country | US
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Telephone | 415-722-6642
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 LILLIAN AVE
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City | SUNNYVALE
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State | CA
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Zip | 94087-3523
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Country | US
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Telephone | 415-722-6642
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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. SCOTT WERDEN
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Credential | M.D.
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Telephone | 415-722-6642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G84749
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License Number State | CA
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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 | G84749
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | G84749
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G84749
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License Number State | CA
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