Provider Demographics
NPI:1609957398
Name:VEIN CENTER OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:VEIN CENTER OF NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-314-7061
Mailing Address - Street 1:801 ENCINO PL NE STE C12
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2618
Mailing Address - Country:US
Mailing Address - Phone:505-247-4849
Mailing Address - Fax:505-247-4850
Practice Address - Street 1:801 ENCINO PL NE STE C12
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2618
Practice Address - Country:US
Practice Address - Phone:505-247-4849
Practice Address - Fax:505-247-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty