MEDICARE: TRAUMA VASCULAR SURGEONS INC

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
1	2086S0127X	Trauma Surgery Physician	A044434	CA
2	2086S0129X	Vascular Surgery Physician	A044434	CA
3	208600000X	Surgery Physician	A044434	CA

General Provider Information

NPI Number	:	1467652859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA VASCULAR SURGEONS INC

Provider Business Mailing Address
First Line	:	12400 VENTURA BLVD # 374
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2406
Country	:	US
Telephone Number	:	618-692-9640
Fax Number	:	618-692-9643

Provider Business Practice Location Address
First Line	:	12400 VENTURA BLVD # 374
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2406
Country	:	US
Telephone Number	:	818-445-8463
Fax Number	:	866-428-9240

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HILLARY A A CHOLLET
Credential	:	MD
Telephone Number	:	818-445-8463

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	01/30/2012

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