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General NPI Number Information
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NPI Number | 1609957398
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Entity Type | Organization
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Legal Business Name | VEIN CENTER OF NEW MEXICO LLC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 ENCINO PL NE STE C12
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2618
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Country | US
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Telephone | 505-247-4849
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Fax | 505-247-4850
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Provider Business Mailing Address
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Address Line | 801 ENCINO PL NE STE C12
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2618
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Country | US
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Telephone | 505-247-4849
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Fax | 505-247-4850
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLE PELOSO
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Credential |
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Telephone | 505-314-7061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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