Basic Information
| Provider Information | |||||||||
| NPI: | 1225136351 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VEIN ESSENTIALS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3987 E PARADISE FALLS DR | ||||||||
| Address2: | SUITE 119 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204086955 | ||||||||
| FaxNumber: | 5204089537 | ||||||||
| Practice Location | |||||||||
| Address1: | 3987 E PARADISE FALLS DR | ||||||||
| Address2: | SUITE 119 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204086955 | ||||||||
| FaxNumber: | 5204089537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | EWY | ||||||||
| AuthorizedOfficialFirstName: | MARVIN | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5208888346 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.