Healthcare Provider Details

I. General information

NPI: 1073929121
Provider Name (Legal Business Name): VEIN CENTER OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 03/26/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 S 4TH AVE
YUMA AZ
85364-7256
US

IV. Provider business mailing address

2603 S 4TH AVE
YUMA AZ
85364-7256
US

V. Phone/Fax

Practice location:
  • Phone: 928-726-8346
  • Fax: 888-418-8515
Mailing address:
  • Phone: 928-750-8975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41014
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL W LARSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 928-750-8975