Provider Demographics
NPI:1538301064
Name:REV VASCULAR INC
Entity Type:Organization
Organization Name:REV VASCULAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEL
Authorized Official - Middle Name:EFRAIN
Authorized Official - Last Name:VELASTEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-966-0320
Mailing Address - Street 1:6620 COYLE AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6338
Mailing Address - Country:US
Mailing Address - Phone:916-966-0320
Mailing Address - Fax:916-966-6598
Practice Address - Street 1:6620 COYLE AVE STE 414
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6338
Practice Address - Country:US
Practice Address - Phone:916-966-0320
Practice Address - Fax:916-966-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty