Basic Information
| Provider Information | |||||||||
| NPI: | 1215213103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASAK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 E GLENARM ST | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267684415 | ||||||||
| FaxNumber: | 6267684415 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 W CALIFORNIA BLVD | ||||||||
| Address2: | GME | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263975187 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2011 | ||||||||
| LastUpdateDate: | 06/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | A125307 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.