Organization
VASCULAR COSMETICS LA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REZA KHODAVERDIAN MD (PRESIDENT)
(949) 636-7775
Entity
Organization
Contact information
Practice address
112 WATERWORKS WAY, SUITE 140, IRVINE, CA 92618-3168
(949) 636-7775
Mailing address
19 HEATHER HILL LN, LAGUNA HILLS, CA 92653-6043
(801) 641-1344
(818) 484-8243
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A127413
MED LICENSE
CA
Enumeration date
11/30/2018
Last updated
07/02/2025
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