MEDICARE: WEST REGIONAL CARDIOTHORACIC & VASCULAR SURGEONS W R VEIN CENTER

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1891028239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST REGIONAL CARDIOTHORACIC & VASCULAR SURGEONS W R VEIN CENTER

Provider Business Mailing Address
First Line	:	5850 CANOGA AVE STE 400
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6554
Country	:	US
Telephone Number	:	805-910-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4527 E CESAR CHAVEZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1116
Country	:	US
Telephone Number	:	323-262-9299
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HAROLD A TABAIE
Credential	:	D.O.
Telephone Number	:	941-720-0731

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	07/28/2023

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