Provider Demographics
NPI:1679946677
Name:CLEAR LAKE VASCULAR ACCESS ASSOCIATES SERIES, PLLC
Entity Type:Organization
Organization Name:CLEAR LAKE VASCULAR ACCESS ASSOCIATES SERIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUPAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-6875
Mailing Address - Street 1:218 W NASA RD 1
Mailing Address - Street 2:SUITE E
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5208
Mailing Address - Country:US
Mailing Address - Phone:281-560-3200
Mailing Address - Fax:
Practice Address - Street 1:218 W NASA RD 1
Practice Address - Street 2:SUITE E
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5208
Practice Address - Country:US
Practice Address - Phone:832-706-3811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty