Provider Demographics
NPI:1255402038
Name:TUCSON VEIN INSTITUTE LLC
Entity type:Organization
Organization Name:TUCSON VEIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP,CNS,CRNFA
Authorized Official - Phone:520-400-8364
Mailing Address - Street 1:2304 N ROSEMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2139
Mailing Address - Country:US
Mailing Address - Phone:520-400-8364
Mailing Address - Fax:520-347-4302
Practice Address - Street 1:2304 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2139
Practice Address - Country:US
Practice Address - Phone:520-400-8364
Practice Address - Fax:520-347-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X, 174400000X
AZRN073883174400000X
AZ37196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1538268065OtherSC OTT LOPEZ NPI INDIV
AZ241526Medicaid
AZ758055Medicaid
AZ003629Medicaid
AZ758055Medicaid
AZ241526Medicaid
AZ003629Medicaid