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General NPI Number Information
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NPI Number | 1689326225
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Entity Type | Organization
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Legal Business Name | MONTEREY BAY VASCULAR, INC.
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 3275 APTOS RANCHO RD STE 1A
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City | APTOS
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State | CA
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Zip | 95003-3971
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Country | US
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Telephone | 631-662-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 3275 APTOS RANCHO RD STE 1A
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City | APTOS
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State | CA
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Zip | 95003-3971
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAZEN HASHISHO
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Credential | MD
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Telephone | 631-662-2130
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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 |
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License Number State |
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