Provider Demographics
NPI:1932691797
Name:VASCULAR INSTITUTE OF NORTHERN CALIFORNIA, A PODIATRY CORPORATION
Entity Type:Organization
Organization Name:VASCULAR INSTITUTE OF NORTHERN CALIFORNIA, A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-235-9100
Mailing Address - Street 1:635 ANDERSON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3505
Mailing Address - Country:US
Mailing Address - Phone:530-979-6226
Mailing Address - Fax:530-758-1896
Practice Address - Street 1:500 UNIVERSITY AVE STE 250
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6525
Practice Address - Country:US
Practice Address - Phone:916-235-9100
Practice Address - Fax:916-680-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty