=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720934698
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VEIN VIXENS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2026
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30375 SUMMERSIDE ST
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-6807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-440-7001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40477 MURRIETA HOT SPRINGS RD SUITE D-1, #1004
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-440-7001
-----------------------------------------------------
Fax | 951-440-7001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LVN/OWNER
-----------------------------------------------------
Name | MRS. JANICE LYNN CORBO
-----------------------------------------------------
Credential | LVN
-----------------------------------------------------
Telephone | 951-440-7001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------