Healthcare Provider Details

I. General information

NPI: 1073138228
Provider Name (Legal Business Name): NA VEIN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2020
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 E OSBORN RD STE 4
PHOENIX AZ
85016-7146
US

IV. Provider business mailing address

1641 E OSBORN RD STE 4
PHOENIX AZ
85016-7146
US

V. Phone/Fax

Practice location:
  • Phone: 541-324-9466
  • Fax: 480-378-8124
Mailing address:
  • Phone: 480-630-2886
  • Fax: 480-378-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NIMA AZARBEHI
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 480-630-2886