Provider Demographics
NPI:1629512595
Name:AHI VEIN AND VASCULAR SPECIALISTS INC A PROFESSIONAL MEDICAL CORPORATI
Entity Type:Organization
Organization Name:AHI VEIN AND VASCULAR SPECIALISTS INC A PROFESSIONAL MEDICAL CORPORATI
Other - Org Name:OCEANA VEIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ISADORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-307-5315
Mailing Address - Street 1:6247 LA JOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 SOUTH EL CAMINO REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:773-307-5315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3894822261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology