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General NPI Number Information
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NPI Number | 1780981886
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Entity Type | Organization
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Legal Business Name | VEIN CENTER OF LAS CRUCES, LLC
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 925 S WALNUT ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-3955
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Country | US
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Telephone | 575-524-5835
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Fax | 575-524-5846
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Provider Business Mailing Address
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Address Line | 1800 N MESA ST 100
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City | EL PASO
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State | TX
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Zip | 79902-3553
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Country | US
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Telephone | 915-577-0121
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Fax | 915-577-9444
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSCAR GUZMAN
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Credential |
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Telephone | 915-577-0121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M9223
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License Number State | TX
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