Provider Demographics
NPI:1891723607
Name:VASCULAR & GENERAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:VASCULAR & GENERAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAYHANABAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-596-6736
Mailing Address - Street 1:3791 KATELLA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2016
Mailing Address - Country:US
Mailing Address - Phone:562-596-6736
Mailing Address - Fax:562-598-5492
Practice Address - Street 1:3791 KATELLA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2016
Practice Address - Country:US
Practice Address - Phone:562-596-6736
Practice Address - Fax:562-598-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046780Medicaid
CAGR0046780Medicaid
CAW10884Medicare ID - Type Unspecified