Provider Demographics
NPI:1053575548
Name:WEST COAST VASCULAR
Entity type:Organization
Organization Name:WEST COAST VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-604-4443
Mailing Address - Street 1:100 N BRENT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2835
Mailing Address - Country:US
Mailing Address - Phone:805-643-3330
Mailing Address - Fax:805-643-3331
Practice Address - Street 1:100 N BRENT ST STE 201
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2835
Practice Address - Country:US
Practice Address - Phone:805-643-3330
Practice Address - Fax:805-643-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA998862086S0129X
CAA795012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty