Healthcare Provider Details

I. General information

NPI: 1689071946
Provider Name (Legal Business Name): CURTIS F. VEAL, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 WASHINGTON BLVD
MARINA DEL REY CA
90292-5548
US

IV. Provider business mailing address

1720 PENMAR AVE
VENICE CA
90291-2940
US

V. Phone/Fax

Practice location:
  • Phone: 206-696-2897
  • Fax:
Mailing address:
  • Phone: 206-696-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number89346
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21928
License Number StateCA

VIII. Authorized Official

Name: DR. CURTIS F VEAL JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 206-696-2897