# VASCULAR COSMETICS LA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366912446
- **Authorized official:** DR. REZA KHODAVERDIAN MD (PRESIDENT)
- **Authorized official phone:** (949) 636-7775

## Contact information

- **Practice address:** 112 WATERWORKS WAY, SUITE 140, IRVINE, CA 92618-3168
- **Practice address phone:** (949) 636-7775
- **Mailing address:** 19 HEATHER HILL LN, LAGUNA HILLS, CA 92653-6043
- **Mailing address phone:** (801) 641-1344
- **Mailing address fax:** (818) 484-8243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/30/2018
- **Last updated:** 07/02/2025