Provider Demographics
NPI:1295193357
Name:KHATEEB VEIN CENTER
Entity Type:Organization
Organization Name:KHATEEB VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATEEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-383-3886
Mailing Address - Street 1:44054 MARGARITA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44054 MARGARITA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2737
Practice Address - Country:US
Practice Address - Phone:951-383-3886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
202K00000X
CAC56111208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty