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General NPI Number Information
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NPI Number | 1659858132
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Entity Type | Organization
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Legal Business Name | VANCOUVER VEIN & SURGICAL CENTER
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 07/26/2018
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Provider Practice Location Address
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Address Line | 13115 NE 4TH ST STE 230
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City | VANCOUVER
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State | WA
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Zip | 98684-5965
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Country | US
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Telephone | 360-448-2047
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Fax | 360-450-2289
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Provider Business Mailing Address
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Address Line | 13115 NE 4TH ST STE 230
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City | VANCOUVER
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State | WA
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Zip | 98684-5965
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Country | US
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Telephone | 360-448-2047
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Fax | 360-450-2289
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER RUBANO
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Credential | MD
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Telephone | 360-448-2047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00044687
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License Number State | WA
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