Southern California Vascular Group, Inc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

A133688 Issued in CA

Legal business name

SOUTHERN CALIFORNIA VASCULAR GROUP, INC

Practice address

1530 Camden Ave Ste 403
Los Angeles, CA 90025-8010

Phone

(310) 914-9150

NPI assigned

Mar 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sammy Eghbalieh, MD

Title

Medical Doctor

Phone

(310) 914-9150

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1376905802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 CAMDEN AVE STE 403",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900258010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 CAMDEN AVE STE 403",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900258010",
            "telephone_number": "310-914-9150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA VASCULAR GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "EGHBALIEH",
        "authorized_official_first_name": "SAMMY",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "310-914-9150",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A133688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.