Provider Demographics
NPI:1396467262
Name:UPLAND VASCULAR CENTER LLC
Entity type:Organization
Organization Name:UPLAND VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-982-4040
Mailing Address - Street 1:1317 W FOOTHILL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3675
Mailing Address - Country:US
Mailing Address - Phone:909-982-4040
Mailing Address - Fax:909-982-4024
Practice Address - Street 1:1317 W FOOTHILL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3675
Practice Address - Country:US
Practice Address - Phone:909-982-4040
Practice Address - Fax:909-982-4024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPLAND VASCULAR CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty