Provider Demographics
NPI:1164933636
Name:CENTER FOR ADVANCED VASCULAR INTERVENTIONS
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED VASCULAR INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHORSANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-905-5904
Mailing Address - Street 1:8635 W 3RD ST STE 695W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6162
Mailing Address - Country:US
Mailing Address - Phone:818-905-5904
Mailing Address - Fax:310-967-2140
Practice Address - Street 1:18226 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4246
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty