Healthcare Provider Details

I. General information

NPI: 1851266589
Provider Name (Legal Business Name): PACIFIC VEIN AND WOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 W ROMNEYA DR STE E
ANAHEIM CA
92801-1805
US

IV. Provider business mailing address

1741 W ROMNEYA DR STE E
ANAHEIM CA
92801-1805
US

V. Phone/Fax

Practice location:
  • Phone: 916-317-8796
  • Fax:
Mailing address:
  • Phone: 916-317-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TYNA NGUYEN
Title or Position: MANAGER
Credential:
Phone: 916-317-8796