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General NPI Number Information
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NPI Number | 1467769877
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Entity Type | Organization
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Legal Business Name | PREMIER VEIN SURGERY CENTER
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 12800 PRESTON RD SUITE 101
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-392-2900
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Fax | 888-223-2813
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Provider Business Mailing Address
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Address Line | 12800 PRESTON RD SUITE 101
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-392-2900
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Fax | 888-223-2813
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Authorized Official
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Title or Position | CHIEF OF SURGERY
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Name | MAURICIO GIRALDO
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Credential | MD
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Telephone | 972-392-2900
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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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