Healthcare Provider Details

I. General information

NPI: 1295193357
Provider Name (Legal Business Name): KHATEEB VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44054 MARGARITA RD SUITE 2
TEMECULA CA
92592-2737
US

IV. Provider business mailing address

44054 MARGARITA RD SUITE 2
TEMECULA CA
92592-2737
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-3886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC56111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAZIN KHATEEB
Title or Position: OWNER
Credential:
Phone: 951-383-3886