TRI-STATE VASCULAR GROUP PLLC NPI 1366993818

NPI Information

TRI-STATE VASCULAR GROUP, PLLC is a vascular surgery surgery in Needles, CA. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. TRI-STATE VASCULAR GROUP, PLLC NPI is 1366993818. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1401 BAILEY AVE BLDG A
NEEDLES, CA
ZIP 92363-103
Phone: (960) 590-0155
Fax: (760) 326-7170

The provider's authorized official is Wantzy Cooper .
The authorized official title is Owner/member Manager and has the following contact phone number (760) 590-0155.

The enumeration date for this NPI number is 10/19/2016 and was last updated on 4/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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