Healthcare Provider Details

I. General information

NPI: 1093869265
Provider Name (Legal Business Name): MESQUITE VEIN AND LASER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FALCON RIDGE PARKWAY #501
MESQUITE NV
89027-8849
US

IV. Provider business mailing address

350 FALCON RIDGE PKWY STE 501
MESQUITE NV
89027-8880
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-8346
  • Fax:
Mailing address:
  • Phone: 702-346-8346
  • Fax: 702-346-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT W RUESS
Title or Position: PRESIDENT
Credential: MD
Phone: 702-346-8346