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General NPI Number Information
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NPI Number | 1841725801
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Entity Type | Organization
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Legal Business Name | THE ORIGINAL VEIN DOCTOR
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 44300 MONTEREY AVE SUITE B
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City | PALM DESERT
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State | CA
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Zip | 92260-3377
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Country | US
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Telephone | 760-341-5777
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Fax | 760-340-4184
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Provider Business Mailing Address
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Address Line | 44300 MONTEREY AVE SUITE B
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City | PALM DESERT
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State | CA
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Zip | 92260-3377
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Country | US
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Telephone | 760-341-5777
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Fax | 760-340-4184
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SANFORD JOSEPH GREENBERG
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Credential | MD
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Telephone | 760-341-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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