Provider Demographics
NPI:1407036288
Name:VASCULAR AND ENDOVASCULAR INSTITUTE OF ORANGE COUNTY, A MEDICAL CORPOR
Entity Type:Organization
Organization Name:VASCULAR AND ENDOVASCULAR INSTITUTE OF ORANGE COUNTY, A MEDICAL CORPOR
Other - Org Name:GARABED PARUNAG 'GARY' NISHANIAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-429-8840
Mailing Address - Street 1:16100 SAND CANYON AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3716
Mailing Address - Country:US
Mailing Address - Phone:949-429-8840
Mailing Address - Fax:
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3716
Practice Address - Country:US
Practice Address - Phone:949-429-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA525372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A525370Medicaid
CA00A525370Medicaid