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General NPI Number Information
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NPI Number | 1730983131
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Entity Type | Organization
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Legal Business Name | AUTHORITY VASCULAR SURGERY INCORPORATED
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1611 W MARCH LN
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City | STOCKTON
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State | CA
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Zip | 95207-6401
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Country | US
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Telephone | 209-645-2020
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Fax | 209-227-1477
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Provider Business Mailing Address
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Address Line | 1611 W MARCH LN
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City | STOCKTON
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State | CA
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Zip | 95207-6401
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Country | US
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Telephone | 209-226-4300
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Fax | 209-227-1477
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIEL HERSCU
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Credential | MD
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Telephone | 209-226-4300
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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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