Healthcare Provider Details

I. General information

NPI: 1790734457
Provider Name (Legal Business Name): VEIN CENTER FOR EXCELLENCE OF DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 TRINITY MILLS RD SUITE 212
DALLAS TX
75287-7603
US

IV. Provider business mailing address

4222 TRINITY MILLS RD SUITE 212
DALLAS TX
75287-7603
US

V. Phone/Fax

Practice location:
  • Phone: 972-267-4600
  • Fax:
Mailing address:
  • Phone: 972-267-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY T HORRILLENO
Title or Position: PRESIDENT
Credential: MD
Phone: 972-267-4600