Healthcare Provider Details

I. General information

NPI: 1649522848
Provider Name (Legal Business Name): SCOTTSDALE VEIN AND LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 E VIA DE VENTURA SUITE 103
SCOTTSDALE AZ
85258-3323
US

IV. Provider business mailing address

8600 E VIA DE VENTURA SUITE 103
SCOTTSDALE AZ
85258-3323
US

V. Phone/Fax

Practice location:
  • Phone: 480-483-0409
  • Fax:
Mailing address:
  • Phone: 480-483-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number12521
License Number StateAZ

VIII. Authorized Official

Name: MRS. DEBORAH LUNDELL
Title or Position: OWNER
Credential:
Phone: 480-483-0208