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General NPI Number Information
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NPI Number | 1720956501
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Entity Type | Organization
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Legal Business Name | MARA VASCULAR SURGERY CENTER INC.
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1101 BAYSIDE DR STE 100
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-1754
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Country | US
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Telephone | 747-777-3188
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Fax | 747-777-4110
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Provider Business Mailing Address
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Address Line | 6720 VALLEY CIRCLE BLVD
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City | WEST HILLS
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State | CA
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Zip | 91307-2809
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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 | OWNER
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Name | RAMSESS KHOSRAVI
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Credential | LLB, RVT
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Telephone | 323-770-9607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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