Provider Demographics
NPI:1013398098
Name:VALLEY VASCULAR ACCESS ASSOCIATES
Entity Type:Organization
Organization Name:VALLEY VASCULAR ACCESS ASSOCIATES
Other - Org Name:VALLEY VASCULAR ACCESS ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOLWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-6875
Mailing Address - Street 1:7015 ALMEDA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2101
Mailing Address - Country:US
Mailing Address - Phone:713-520-6875
Mailing Address - Fax:
Practice Address - Street 1:214 W SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5346
Practice Address - Country:US
Practice Address - Phone:713-520-6875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty