Provider Demographics
NPI:1184789950
Name:VASCULAR SPECIALTIES INC
Entity type:Organization
Organization Name:VASCULAR SPECIALTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:RCS RCIS FASE
Authorized Official - Phone:818-989-9991
Mailing Address - Street 1:6907 HAYVENHURST AVENUE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4632
Mailing Address - Country:US
Mailing Address - Phone:818-989-9991
Mailing Address - Fax:818-373-7383
Practice Address - Street 1:6907 HAYVENHURST AVENUE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4632
Practice Address - Country:US
Practice Address - Phone:818-989-9991
Practice Address - Fax:818-373-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
Not Answered246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG022Medicare ID - Type Unspecified