Provider Demographics
NPI:1235464967
Name:JOSEPH VARDAYO M.D., INC
Entity Type:Organization
Organization Name:JOSEPH VARDAYO M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FAMIL
Authorized Official - Last Name:VARDAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-981-9308
Mailing Address - Street 1:701 E 28TH ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2702
Mailing Address - Country:US
Mailing Address - Phone:562-981-9308
Mailing Address - Fax:562-981-9318
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:SUITE 314
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2702
Practice Address - Country:US
Practice Address - Phone:562-981-9308
Practice Address - Fax:562-981-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740233493OtherNPI
CAA43961Medicare UPIN