Healthcare Provider Details

I. General information

NPI: 1255402038
Provider Name (Legal Business Name): TUCSON VEIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 N ROSEMONT BLVD
TUCSON AZ
85712-2139
US

IV. Provider business mailing address

2304 N ROSEMONT BLVD
TUCSON AZ
85712-2139
US

V. Phone/Fax

Practice location:
  • Phone: 520-400-8364
  • Fax: 520-347-4302
Mailing address:
  • Phone: 520-400-8364
  • Fax: 520-347-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SCOTT FRANK LOPEZ
Title or Position: OWNER
Credential: FNP,CNS,CRNFA
Phone: 520-400-8364