Provider Demographics
NPI:1962800318
Name:WEST REGIONAL CARDIOTHORACIC & VASCULAR SURGEONS W R VEIN CENTER
Entity type:Organization
Organization Name:WEST REGIONAL CARDIOTHORACIC & VASCULAR SURGEONS W R VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:A
Authorized Official - Last Name:TABAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-720-0731
Mailing Address - Street 1:5475 E LA PALMA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:941-720-0731
Mailing Address - Fax:
Practice Address - Street 1:5475 E LA PALMA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:941-720-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty