Provider Demographics
NPI:1629070610
Name:VASCULAR AND INTERVENTIONAL SPECIALISTS OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:VASCULAR AND INTERVENTIONAL SPECIALISTS OF ORANGE COUNTY, INC.
Other - Org Name:FLANIGAN AND HARWARD, A MEDICAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-560-4450
Mailing Address - Street 1:1010 W LA VETA AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4303
Mailing Address - Country:US
Mailing Address - Phone:714-560-4450
Mailing Address - Fax:714-560-4455
Practice Address - Street 1:1010 W LA VETA AVE STE 320
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4303
Practice Address - Country:US
Practice Address - Phone:714-560-4450
Practice Address - Fax:714-560-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40069FMedicaid
CK3084OtherRAILROAD MEDICARE PIN
CAGR009300Medicaid
ZZZ05659ZOtherBLUE SHIELD OF CA
CAZZT40069FMedicaid