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General NPI Number Information
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NPI Number | 1245658988
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Entity Type | Organization
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Legal Business Name | GLENDALE VEIN CLINIC, PC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 801 S CHEVY CHASE DR
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City | GLENDALE
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State | CA
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Zip | 91205-4431
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Country | US
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Telephone | 323-798-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 832
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City | NORTHBROOK
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State | IL
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Zip | 60065-0832
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Country | US
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Telephone | 847-593-8460
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | FLORA KATSNELSON
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Credential | MD
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Telephone | 847-305-8460
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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 | A106254
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License Number State | CA
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