Provider Demographics
NPI:1871916494
Name:GREATER LONG BEACH PERIPHERAL ARTERIAL DISEASE CENTER, A PROFESSIONAL
Entity type:Organization
Organization Name:GREATER LONG BEACH PERIPHERAL ARTERIAL DISEASE CENTER, A PROFESSIONAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-867-5300
Mailing Address - Street 1:16506 LAKEWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5164
Mailing Address - Country:US
Mailing Address - Phone:562-867-5300
Mailing Address - Fax:562-867-8666
Practice Address - Street 1:3 W HAWTHORN PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1446
Practice Address - Country:US
Practice Address - Phone:847-388-2001
Practice Address - Fax:847-388-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty