Provider Demographics
NPI:1417127325
Name:ADVANCED VASCULAR & ENDOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED VASCULAR & ENDOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-673-6950
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:SUITE 322
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-673-6950
Mailing Address - Fax:310-671-9989
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:SUITE 322
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-673-6950
Practice Address - Fax:310-671-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty