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General NPI Number Information
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NPI Number | 1548626294
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Entity Type | Organization
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Legal Business Name | NEWPORT COAST VEIN CARE, INC.
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 447 OLD NEWPORT BLVD SUITE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4257
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Country | US
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Telephone | 949-612-8676
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Fax | 949-200-9695
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Provider Business Mailing Address
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Address Line | 447 OLD NEWPORT BLVD SUITE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4257
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Country | US
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Telephone | 949-612-8676
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Fax | 949-200-9695
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AIDAN ALOYSIUS RANEY
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Credential | M.D.
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Telephone | 949-612-8676
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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 | 3783857
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License Number State | CA
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