Provider Demographics
NPI:1235498718
Name:VANGUARD MEDICAL GROUP INC
Entity Type:Organization
Organization Name:VANGUARD MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SYLVESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-738-0123
Mailing Address - Street 1:3545 WILSHIRE BLVD
Mailing Address - Street 2:#340
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2354
Mailing Address - Country:US
Mailing Address - Phone:213-738-0123
Mailing Address - Fax:213-738-0134
Practice Address - Street 1:3545 WILSHIRE BLVD
Practice Address - Street 2:#340
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2354
Practice Address - Country:US
Practice Address - Phone:213-738-0123
Practice Address - Fax:213-738-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty