Provider Demographics
NPI:1760257349
Name:VEGAS VEIN VIXEN LLC
Entity Type:Organization
Organization Name:VEGAS VEIN VIXEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:DR
Authorized Official - First Name:TORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:562-665-5770
Mailing Address - Street 1:9433 VALLEY HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0152
Mailing Address - Country:US
Mailing Address - Phone:562-665-5770
Mailing Address - Fax:
Practice Address - Street 1:9433 VALLEY HILLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0152
Practice Address - Country:US
Practice Address - Phone:562-665-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-23
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty