Provider Demographics
NPI:1245739820
Name:NORTHRIDGE VASCULAR CENTER A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:NORTHRIDGE VASCULAR CENTER A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSOMULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-241-7160
Mailing Address - Street 1:10605 BALBOA BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:424-241-7160
Mailing Address - Fax:
Practice Address - Street 1:19331 BUSINESS CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3533
Practice Address - Country:US
Practice Address - Phone:818-709-5555
Practice Address - Fax:818-739-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty