Healthcare Provider Details

I. General information

NPI: 1225528565
Provider Name (Legal Business Name): VEIN ENVY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD STE 226
LITCHFIELD PARK AZ
85340-9426
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 226
LITCHFIELD PARK AZ
85340-9426
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-1050
  • Fax: 623-248-6952
Mailing address:
  • Phone: 623-233-1050
  • Fax: 623-248-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number006421
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMETHYST LAFLEUR
Title or Position: BILLER/CODER/CREDENTIALING SPEC
Credential:
Phone: 623-233-1050