Tri-State Vascular Group, Pllc
NPI #1366993818 in Needles, California
Provider Information
- NPI Number
- 1366993818
- Entity Type
- Organization
- Organization Name
- Tri-State Vascular Group, Pllc
- Primary Specialty
- Surgery - Vascular Surgery
- Enumeration Date
- Oct 19, 2016
- Last Updated
- Apr 8, 2024
Practice Location
- Address
- 1401 BAILEY AVE BLDG A
- City
- Needles
- State
- California
- ZIP Code
- 92363-3103
- Phone
- (960) 590-0155
Authorized Official
- Name
- WANTZY COOPER, D.O.
- Title
- OWNER/MEMBER MANAGER
- Phone
- (760) 590-0155
Specialties & Taxonomy Codes
| Specialty |
|---|
| General Practice |
| Surgery - Vascular Surgery — Vascular Surgery |
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