# VANGUARD VEIN CENTERS

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

## Provider details

- **NPI number:** 1699472191
- **Authorized official:** DR. OLLIE JOSEPH JACKSON III MD (OWNER)
- **Authorized official phone:** (310) 709-7460

## Contact information

- **Practice address:** 10884 SANTA MONICA BLVD STE 403, LOS ANGELES, CA 90025-7639
- **Practice address phone:** (310) 709-7460
- **Mailing address:** 10884 SANTA MONICA BLVD STE 403, LOS ANGELES, CA 90025-7639

## Taxonomy

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

## Other

- **Enumeration date:** 02/14/2023
- **Last updated:** 02/14/2023