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General NPI Number Information
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NPI Number | 1962800318
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Entity Type | Organization
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Legal Business Name | WEST REGIONAL CARDIOTHORACIC & VASCULAR SURGEONS W R VEIN CENTER
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 5475 E LA PALMA AVE SUITE 204
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City | ANAHEIM
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State | CA
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Zip | 92807-2075
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Country | US
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Telephone | 941-720-0731
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Fax |
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Provider Business Mailing Address
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Address Line | 5475 E LA PALMA AVE SUITE 204
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City | ANAHEIM
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State | CA
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Zip | 92807-2075
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Country | US
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Telephone | 941-720-0731
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | HAROLD A TABAIE
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Credential | DO
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Telephone | 941-720-0731
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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