Provider Demographics
NPI:1336441310
Name:VIP VEIN CENTER
Entity Type:Organization
Organization Name:VIP VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLARDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-371-0390
Mailing Address - Street 1:2410 SAMARITAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3909
Mailing Address - Country:US
Mailing Address - Phone:408-371-8346
Mailing Address - Fax:408-796-7787
Practice Address - Street 1:2410 SAMARITAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3909
Practice Address - Country:US
Practice Address - Phone:408-371-8346
Practice Address - Fax:408-796-7787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNIRAD MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA784152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty