Healthcare Provider Details

I. General information

NPI: 1043480700
Provider Name (Legal Business Name): VEIN HELP OF ORLANDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2008
Last Update Date: 03/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 W LAKE MARY BLVD STE 324
LAKE MARY FL
32746-3315
US

IV. Provider business mailing address

4106 W LAKE MARY BLVD STE 324
LAKE MARY FL
32746-3315
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-8484
  • Fax: 407-892-8485
Mailing address:
  • Phone: 407-892-8484
  • Fax: 407-892-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberBM8707804
License Number StateFL

VIII. Authorized Official

Name: JOHN MAURIELLO
Title or Position: OWNER
Credential: MD
Phone: 407-892-8484