Provider Demographics
NPI:1487363321
Name:SOUTHERN CALIFORNIA VEIN & WOUND CARE CENTER INC.
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA VEIN & WOUND CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-799-5058
Mailing Address - Street 1:9191 WESTMINSTER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2751
Mailing Address - Country:US
Mailing Address - Phone:714-899-2000
Mailing Address - Fax:714-899-0051
Practice Address - Street 1:9191 WESTMINSTER AVE STE 211
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2751
Practice Address - Country:US
Practice Address - Phone:714-899-2000
Practice Address - Fax:714-899-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty