Provider Demographics
NPI:1871230771
Name:VEIN ABOUT YOU A PROF PHYSICIAN ASSISTANT CORP
Entity Type:Organization
Organization Name:VEIN ABOUT YOU A PROF PHYSICIAN ASSISTANT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:RENE DE COTRET
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:310-569-5869
Mailing Address - Street 1:3344 LEES AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2777 PACIFIC AVE STE 206M
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2627
Practice Address - Country:US
Practice Address - Phone:562-980-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty