Provider Demographics
NPI:1861967168
Name:LOS ANGELES HEART AND VEIN CENTER INC
Entity type:Organization
Organization Name:LOS ANGELES HEART AND VEIN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GHAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-913-4303
Mailing Address - Street 1:1300 N VERMONT AVE STE 809
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6098
Mailing Address - Country:US
Mailing Address - Phone:323-660-7113
Mailing Address - Fax:323-660-7116
Practice Address - Street 1:1300 N VERMONT AVE STE 809
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6098
Practice Address - Country:US
Practice Address - Phone:323-660-7113
Practice Address - Fax:323-660-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7974939Medicaid