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General NPI Number Information
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NPI Number | 1437401106
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Entity Type | Organization
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Legal Business Name | PALM VEIN CENTER LLC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 16944 W BELL RD #603
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City | SURPRISE
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State | AZ
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Zip | 85374-8950
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Country | US
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Telephone | 623-201-4777
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Fax | 623-201-4770
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Provider Business Mailing Address
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Address Line | 16944 W BELL RD SUITE 603
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City | SURPRISE
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State | AZ
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Zip | 85374-8950
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Country | US
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Telephone | 623-201-4777
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Fax | 623-201-4770
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Authorized Official
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Title or Position | CEO
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Name | MR. JIMMY H DRAGON
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Credential | RVT
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Telephone | 623-201-4777
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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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