Healthcare Provider Details

I. General information

NPI: 1003704867
Provider Name (Legal Business Name): VEIN & VASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR BLVD
LAS CRUCES NM
88011-8243
US

IV. Provider business mailing address

4603 SANDALWOOD DR
LAS CRUCES NM
88011-9634
US

V. Phone/Fax

Practice location:
  • Phone: 505-363-3377
  • Fax:
Mailing address:
  • Phone: 505-363-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANDRAN VEDAMANIKAM
Title or Position: OWNER
Credential: MD
Phone: 505-363-3377