Provider Demographics
NPI:1255758025
Name:INSTITUTE FOR VASCULAR TESTING
Entity type:Organization
Organization Name:INSTITUTE FOR VASCULAR TESTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLYXENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKINOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-376-3626
Mailing Address - Street 1:2255 S BASCOM AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6903
Mailing Address - Country:US
Mailing Address - Phone:408-376-3626
Mailing Address - Fax:408-871-2377
Practice Address - Street 1:2255 S BASCOM AVE STE 205
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6903
Practice Address - Country:US
Practice Address - Phone:408-376-3626
Practice Address - Fax:408-871-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty