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General NPI Number Information
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NPI Number | 1013785005
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Entity Type | Organization
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Legal Business Name | CA VEIN MEDICAL PC
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 15706 POMERADO RD STE N202
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City | POWAY
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State | CA
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Zip | 92064-2067
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Country | US
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Telephone | 669-201-0667
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Fax |
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Provider Business Mailing Address
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Address Line | 244 MADISON AVE # 1120
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City | NEW YORK
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State | NY
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Zip | 10016-2817
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Country | US
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Telephone | 669-201-0667
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL NGUYEN
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Credential | MD
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Telephone | 669-201-0667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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