Provider Demographics
NPI:1437182136
Name:LOS ANGELES VASCULAR SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LOS ANGELES VASCULAR SPECIALISTS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-902-5786
Mailing Address - Street 1:PO BOX 14250
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91409-4250
Mailing Address - Country:US
Mailing Address - Phone:818-902-5786
Mailing Address - Fax:818-904-3708
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4542
Practice Address - Country:US
Practice Address - Phone:818-902-5786
Practice Address - Fax:818-904-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA198652086S0129X
CAA747202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC8660OtherRAILROAD MEDICARE
CAW1211Medicare PIN
CACC8660OtherRAILROAD MEDICARE