Individual
DR. CARLETON THOMAS VANGSNESS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1520 SAN PABLO ST, LOS ANGELES, CA 90033-5314
(323) 442-5860
(323) 442-6990
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-5860
(323) 442-6296
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
G56949
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
G56949
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G569490
BLUE SHIELD
CA
05
—
00G569490
—
CA
Enumeration date
05/18/2006
Last updated
09/30/2016
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