Basic Information
| Provider Information | |||||||||
| NPI: | 1467652859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRAUMA VASCULAR SURGEONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12400 VENTURA BLVD # 374 | ||||||||
| Address2: | |||||||||
| City: | STUDIO CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916042406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186929640 | ||||||||
| FaxNumber: | 6186929643 | ||||||||
| Practice Location | |||||||||
| Address1: | 12400 VENTURA BLVD # 374 | ||||||||
| Address2: | |||||||||
| City: | STUDIO CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916042406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184458463 | ||||||||
| FaxNumber: | 8664289240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHOLLET | ||||||||
| AuthorizedOfficialFirstName: | HILLARY | ||||||||
| AuthorizedOfficialMiddleName: | A A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8184458463 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | A044434 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0129X | A044434 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | A044434 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.