Provider Demographics
NPI:1073558235
Name:VOURNAS, JORGE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:THOMAS
Last Name:VOURNAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-751-3183
Practice Address - Street 1:4101 TORRANCE BLVD
Practice Address - Street 2:EM DEPT
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4607
Practice Address - Country:US
Practice Address - Phone:310-540-7676
Practice Address - Fax:405-751-3183
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56035207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560350Medicaid
CAG67956Medicare UPIN
CAHA56035BMedicare ID - Type Unspecified
CA00A560350Medicaid
CA00A560350Medicare ID - Type Unspecified