Provider Demographics
NPI:1780981886
Name:VEIN CENTER OF LAS CRUCES, LLC
Entity type:Organization
Organization Name:VEIN CENTER OF LAS CRUCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-577-0121
Mailing Address - Street 1:1800 N MESA ST
Mailing Address - Street 2:100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3553
Mailing Address - Country:US
Mailing Address - Phone:915-577-0121
Mailing Address - Fax:915-577-9444
Practice Address - Street 1:925 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3955
Practice Address - Country:US
Practice Address - Phone:575-524-5835
Practice Address - Fax:575-524-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty