Healthcare Provider Details

I. General information

NPI: 1780981886
Provider Name (Legal Business Name): VEIN CENTER OF LAS CRUCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S WALNUT ST
LAS CRUCES NM
88001-3955
US

IV. Provider business mailing address

1800 N MESA ST 100
EL PASO TX
79902-3553
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-5835
  • Fax: 575-524-5846
Mailing address:
  • Phone: 915-577-0121
  • Fax: 915-577-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM9223
License Number StateTX

VIII. Authorized Official

Name: OSCAR GUZMAN
Title or Position: PRESIDENT
Credential:
Phone: 915-577-0121