Provider Demographics
NPI:1912008582
Name:LA VASCULAR AND ENDOVASCULAR SURGERY, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LA VASCULAR AND ENDOVASCULAR SURGERY, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-842-4400
Mailing Address - Street 1:PO BOX 16335
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6335
Mailing Address - Country:US
Mailing Address - Phone:818-842-4400
Mailing Address - Fax:818-842-4401
Practice Address - Street 1:2950 W BURBANK BLVD
Practice Address - Street 2:STE. 208
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2309
Practice Address - Country:US
Practice Address - Phone:818-842-4400
Practice Address - Fax:818-842-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA644852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A644850Medicaid
CAH76523Medicare UPIN
CAW17284Medicare PIN