Provider Demographics
NPI:1922166099
Name:MILTON VANA JR., M.D., INC
Entity Type:Organization
Organization Name:MILTON VANA JR., M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:VANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:949-415-0677
Mailing Address - Street 1:31873 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6860
Mailing Address - Country:US
Mailing Address - Phone:949-415-0677
Mailing Address - Fax:949-415-0676
Practice Address - Street 1:31873 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6860
Practice Address - Country:US
Practice Address - Phone:949-415-0677
Practice Address - Fax:949-415-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G240290208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G240290Medicaid
CAA42135Medicare UPIN
CAG24029Medicare PIN