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Organization
VASCULAR AND ENDOVASCULAR SURGERY, PC
Active
Organization
VASCULAR AND ENDOVASCULAR SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABID C MOGANNAM MD (VASCULAR SURGEON)
(408) 899-8272
Entity
Organization
Contact information
Practice address
2505 SAMARITAN DR STE 503, SAN JOSE, CA 95124-4015
(408) 558-3600
(408) 614-2001
Mailing address
1900 CAMDEN AVE STE 101, SAN JOSE, CA 95124-2944
(408) 558-3600
(408) 614-2001
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
12/03/2018
Last updated
12/04/2018
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