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General NPI Number Information
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NPI Number | 1982029732
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA VASCULAR INSTITUTE INC
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 8750 WILSHIRE BLVD SUITE 150
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2703
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Country | US
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Telephone | 424-260-8474
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49953
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City | LOS ANGELES
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State | CA
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Zip | 90049-0953
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Country | US
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Telephone | 424-260-8474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMIEL MOSHFEGH
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Credential | M.D.
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Telephone | 424-260-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A109904
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License Number State | CA
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