Basic Information
| Provider Information | |||||||||
| NPI: | 1811319635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VARICOSE VEIN SOLUTIONS, MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18226 VENTURA BOULEVARD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913564246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183456126 | ||||||||
| FaxNumber: | 8183455061 | ||||||||
| Practice Location | |||||||||
| Address1: | 18840 VENTURA BLVD STE 100B | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183456126 | ||||||||
| FaxNumber: | 8183455061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2014 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | NASSOURA | ||||||||
| AuthorizedOfficialFirstName: | ZAHI | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8183456126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.