Provider Demographics
NPI:1790049617
Name:SONORAN VEIN AND ENDOVASCULAR LLC
Entity Type:Organization
Organization Name:SONORAN VEIN AND ENDOVASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-637-7784
Mailing Address - Street 1:10115 E BELL RD
Mailing Address - Street 2:STE 107, #497
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2189
Mailing Address - Country:US
Mailing Address - Phone:602-374-4101
Mailing Address - Fax:602-441-0522
Practice Address - Street 1:9200 W UNION HILLS DR
Practice Address - Street 2:STE A-103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8210
Practice Address - Country:US
Practice Address - Phone:602-374-4101
Practice Address - Fax:602-441-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ712219Medicaid
AZZ90295Medicare PIN