Provider Demographics
NPI:1154888014
Name:PACIFIC VASCULAR ASSOCIATES, LLC
Entity type:Organization
Organization Name:PACIFIC VASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMR
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SERGANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-870-7393
Mailing Address - Street 1:98-1079 MOANALUA RD STE 620
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4716
Mailing Address - Country:US
Mailing Address - Phone:808-486-7775
Mailing Address - Fax:808-486-5558
Practice Address - Street 1:98-1079 MOANALUA RD STE 620
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4716
Practice Address - Country:US
Practice Address - Phone:808-486-7775
Practice Address - Fax:808-486-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty