Las Vegas Vein Center | |
2901 N Tenaya Way Ste 200 Las Vegas NV 89128-1404 | |
(702) 852-2000 | |
(702) 821-1704 |
Full Name | Las Vegas Vein Center |
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Speciality | Internal Medicine |
Location | 2901 N Tenaya Way Ste 200, Las Vegas, Nevada |
Authorized Official Name and Position | Fauzia Carullo I (PRESIDENT/OWNER) |
Authorized Official Contact | 7028522000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Las Vegas Vein Center 2901 N Tenaya Way Ste 200 Las Vegas NV 89128-1404 Ph: (702) 852-2000 | Las Vegas Vein Center 2901 N Tenaya Way Ste 200 Las Vegas NV 89128-1404 Ph: (702) 852-2000 |
NPI Number | 1932498318 |
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Provider Enumeration Date | 04/06/2011 |
Last Update Date | 12/19/2018 |
Medicare PECOS PAC ID | 6204010424 |
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Medicare Enrollment ID | O20110413000615 |
Identifier | Type | State | Issuer |
---|---|---|---|
1932498318 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 13682 (Nevada) | Primary |
Provider Name | Ralph Carullo |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1538314661 PECOS PAC ID: 3173665130 Enrollment ID: I20110331000570 |
Provider Name | Fauzia I Carullo |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790818433 PECOS PAC ID: 5395827026 Enrollment ID: I20110413000625 |
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