Provider Demographics
NPI:1194498832
Name:CALIFORNIA VASCULAR HEALTH INSTITUTE LLC
Entity type:Organization
Organization Name:CALIFORNIA VASCULAR HEALTH INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARAJALLAH
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:ALKASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-745-6463
Mailing Address - Street 1:411 N CENTRAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2092
Mailing Address - Country:US
Mailing Address - Phone:818-745-6463
Mailing Address - Fax:
Practice Address - Street 1:411 N CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2092
Practice Address - Country:US
Practice Address - Phone:818-745-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301087094OtherLICENSE