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General NPI Number Information
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NPI Number | 1366396228
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Entity Type | Organization
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Legal Business Name | ELEVATED VEIN SOLUTIONS LLC
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 8045 W MARY ANN DR
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City | PEORIA
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State | AZ
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Zip | 85382-5412
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Country | US
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Telephone | 602-480-6328
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Fax |
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Provider Business Mailing Address
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Address Line | 8045 W MARY ANN DR
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City | PEORIA
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State | AZ
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Zip | 85382-5412
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Country | US
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Telephone | 602-480-6328
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO/SONOGRAPHER
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Name | LYDIA GASPARRO DERHAAG
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Credential | RVS
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Telephone | 602-480-6328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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