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: 09/27/2026
Certification Date: 09/27/2026
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: 480-630-2886
  • 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 Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TODD VANDUZER
Title or Position: MANAGER
Credential:
Phone: 760-521-4721