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NPI Code Detail

MEDICARE: LOS ANGELES VASCULAR SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION

MEDICARE: LOS ANGELES VASCULAR SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0129XVascular Surgery PhysicianA74720CA
22086S0129XVascular Surgery PhysicianA19865CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC8660OTHERCARAILROAD MEDICARE

General Provider Information

NPI Number : 1437182136
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOS ANGELES VASCULAR SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 14250
Second Line :
City : VAN NUYS
State : CA
Zip : 91409-4250
Country : US
Telephone Number : 818-902-5786
Fax Number : 818-904-3708
Provider Business Practice Location Address
First Line : 15107 VANOWEN ST
Second Line :
City : VAN NUYS
State : CA
Zip : 91405-4542
Country : US
Telephone Number : 818-902-5786
Fax Number : 818-904-3708
Authorized Official
Title or Position : PRESIDENT
Name : GEORGE ANDROS
Credential : M.D.
Telephone Number : 818-902-5786
Provider Enumeration Date : 07/08/2006
Last Update Date : 02/25/2011

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1962478339 — DR. MARK MIGDAL M.D.
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1053370627 — MARVIN I RETSKY, MD AND DENNIS KASIMIAN, MD A PROFESSIONAL CORPORATION
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1295795227 — CHENDUEN HWANG MD
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1386605327 — SANANI MEDCORP
Practice Location Address:
15107 VANOWEN ST
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91405-4542
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Practice Fax: 818-715-1722

Directions to “LOS ANGELES VASCULAR SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION ” Practice Location

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