Healthcare Provider Details

I. General information

NPI: 1720205529
Provider Name (Legal Business Name): PALMETTO VEIN & AESTHETIC CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 SUNSET BLVD SUITE C
LEXINGTON SC
29072-9151
US

IV. Provider business mailing address

4715 SUNSET BLVD SUITE C
LEXINGTON SC
29072-9151
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-8346
  • Fax: 803-359-0978
Mailing address:
  • Phone: 803-359-8346
  • Fax: 803-359-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL M ESPINOZA
Title or Position: PHYSICIAN
Credential: MD
Phone: 803-359-8346