# BANIPAL MEDICAL CORP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Vascular and Vein Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417576307
- **Authorized official:** DR. SIMPLEDEEP BANIPAL MD (VASCULAR SURGEON)
- **Authorized official phone:** (818) 926-5272

## Contact information

- **Practice address:** 355 E 21ST ST STE C, SAN BERNARDINO, CA 92404-4851
- **Practice address phone:** (818) 926-5272
- **Practice address fax:** (573) 250-7382
- **Mailing address:** 19400 TURTLE RIDGE LN, PORTER RANCH, CA 91326-3803
- **Mailing address phone:** (818) 926-5272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2020
- **Last updated:** 04/10/2020