Healthcare Provider Details

I. General information

NPI: 1891291902
Provider Name (Legal Business Name): VASCULAR INSTITUTE OF HENDERSON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST STE 1011
HENDERSON NV
89014-8901
US

IV. Provider business mailing address

375 N STEPHANIE ST STE 1011
HENDERSON NV
89014-8901
US

V. Phone/Fax

Practice location:
  • Phone: 702-899-8095
  • Fax: 844-323-0963
Mailing address:
  • Phone: 702-899-8095
  • Fax: 844-323-0963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA ARREDONDO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 702-899-8095