Basic Information
| Provider Information | |||||||||
| NPI: | 1194100685 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR CENTER OF INTERVENTION, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1191 E HERNDON AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105477337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1191 E HERNDON AVE | ||||||||
| Address2: | STE 102 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105477337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2015 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5597021390 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | G84634 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.