Provider Demographics
NPI:1932498318
Name:FAUZIA CARULLO MD PROF CORP
Entity Type:Organization
Organization Name:FAUZIA CARULLO MD PROF CORP
Other - Org Name:LAS VEGAS VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAUZIA
Authorized Official - Middle Name:CARULLO
Authorized Official - Last Name:I
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-852-2000
Mailing Address - Street 1:2901 N TENAYA WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1404
Mailing Address - Country:US
Mailing Address - Phone:702-852-2000
Mailing Address - Fax:702-821-1704
Practice Address - Street 1:2901 N TENAYA WAY STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1404
Practice Address - Country:US
Practice Address - Phone:702-852-2000
Practice Address - Fax:702-821-1704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAUZIA CARULLO, MD PROF. CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty