Healthcare Provider Details

I. General information

NPI: 1194340539
Provider Name (Legal Business Name): ARTERY AND VEIN SPECIALISTS OF AMERICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E AMBER ST STE 103
SAN ANTONIO TX
78221-2456
US

IV. Provider business mailing address

2222 W PINNACLE PEAK RD STE 260
PHOENIX AZ
85027-1224
US

V. Phone/Fax

Practice location:
  • Phone: 210-660-5040
  • Fax: 210-660-5045
Mailing address:
  • Phone: 480-626-1746
  • Fax: 480-626-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDEEP RAO
Title or Position: OWNER
Credential: MD
Phone: 480-626-1746