Provider Demographics
NPI:1417222860
Name:SAN GABRIEL VALLEY VASCULAR INSTITUTE
Entity Type:Organization
Organization Name:SAN GABRIEL VALLEY VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-223-1100
Mailing Address - Street 1:1100 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1916
Mailing Address - Country:US
Mailing Address - Phone:213-223-1100
Mailing Address - Fax:213-223-1104
Practice Address - Street 1:506 W VALLEY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3731
Practice Address - Country:US
Practice Address - Phone:213-977-7418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty