Healthcare Provider Details

I. General information

NPI: 1043896533
Provider Name (Legal Business Name): VEIN AND AESTHETICS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9041 MAGNOLIA AVE STE 3
RIVERSIDE CA
92503-3941
US

IV. Provider business mailing address

9041 MAGNOLIA AVE STE 3
RIVERSIDE CA
92503-3941
US

V. Phone/Fax

Practice location:
  • Phone: 951-384-0988
  • Fax: 951-848-0987
Mailing address:
  • Phone: 951-384-0988
  • Fax: 951-848-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUKE KAMEL
Title or Position: PRESIDENT
Credential: MD
Phone: 562-472-3266