Provider Demographics
NPI:1104975713
Name:VASCULAR ASSOCIATES OF SAN DIEGO
Entity type:Organization
Organization Name:VASCULAR ASSOCIATES OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GUZZETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-460-6200
Mailing Address - Street 1:8860 CENTER DR
Mailing Address - Street 2:450
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-460-6200
Mailing Address - Fax:619-460-6262
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:450
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-460-6200
Practice Address - Fax:619-460-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG293172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20440Medicare ID - Type UnspecifiedGROUP MEDICARE