Provider Demographics
NPI:1205886108
Name:PACIFIC COAST CARDIAC & VASCULAR SURGEONS
Entity type:Organization
Organization Name:PACIFIC COAST CARDIAC & VASCULAR SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CARDIAC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:AUGUSTUS
Authorized Official - Last Name:GAUDIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-366-0225
Mailing Address - Street 1:2900 WHIPPLE AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2851
Mailing Address - Country:US
Mailing Address - Phone:650-366-0225
Mailing Address - Fax:650-364-3728
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2851
Practice Address - Country:US
Practice Address - Phone:650-366-0225
Practice Address - Fax:650-364-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP2153OtherRAILROAD MEDICARE
CAGR0052800Medicaid
CAZZZ23469ZMedicare PIN
CAZZZ05047ZMedicare PIN
CAAP493AMedicare PIN
CACP2153OtherRAILROAD MEDICARE
CAZZZ02406ZMedicare PIN