Healthcare Provider Details

I. General information

NPI: 1699666255
Provider Name (Legal Business Name): SONORAN VEIN AND ENDOVASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9192 W UNION HILLS DR
PEORIA AZ
85382-8208
US

IV. Provider business mailing address

9192 W UNION HILLS DR
PEORIA AZ
85382-8208
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-4101
  • Fax: 602-441-0522
Mailing address:
  • Phone: 602-374-4101
  • Fax: 602-441-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID NYE
Title or Position: CMO
Credential: DO
Phone: 480-363-7778