Provider Demographics
NPI:1912937814
Name:SOUTHERN CALIFORNIA VASCULAR ASSOCIATES, INC.
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA VASCULAR ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-532-0793
Mailing Address - Street 1:1310 W STEWART DR STE 406
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3855
Mailing Address - Country:US
Mailing Address - Phone:714-532-0793
Mailing Address - Fax:714-780-0053
Practice Address - Street 1:1310 W STEWART DR STE 406
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3855
Practice Address - Country:US
Practice Address - Phone:714-532-0793
Practice Address - Fax:714-516-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2410301174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0093510Medicaid
CAW15964Medicare ID - Type UnspecifiedPROVIDER GROUP NUMBER