Healthcare Provider Details

I. General information

NPI: 1245496017
Provider Name (Legal Business Name): VEIN CLINIC OF LAS VEGAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 W CHARLESTON BLVD
LAS VEGAS NV
89102-1835
US

IV. Provider business mailing address

3309 W CHARLESTON BLVD
LAS VEGAS NV
89102-1835
US

V. Phone/Fax

Practice location:
  • Phone: 702-838-0444
  • Fax: 702-878-8643
Mailing address:
  • Phone: 702-838-0444
  • Fax: 702-878-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAJID H BASHY
Title or Position: OWNER
Credential:
Phone: 702-838-0444