Provider Demographics
NPI:1871862607
Name:LOS ANGELES VASCULAR SERVICES, INC
Entity Type:Organization
Organization Name:LOS ANGELES VASCULAR SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUATAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-869-0871
Mailing Address - Street 1:1012 W BEVERLY BLVD
Mailing Address - Street 2:SUITE 873
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4139
Mailing Address - Country:US
Mailing Address - Phone:323-869-0871
Mailing Address - Fax:323-869-0875
Practice Address - Street 1:620 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3624
Practice Address - Country:US
Practice Address - Phone:323-869-0871
Practice Address - Fax:323-869-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-709622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty