Healthcare Provider Details

I. General information

NPI: 1841810363
Provider Name (Legal Business Name): VEIN PLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E 17TH ST STE 107
SANTA ANA CA
92705-6862
US

IV. Provider business mailing address

1945 E 17TH ST STE 107
SANTA ANA CA
92705-6862
US

V. Phone/Fax

Practice location:
  • Phone: 714-366-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SHARIFI
Title or Position: OWNER
Credential:
Phone: 714-500-7714