Provider Demographics
NPI:1154545986
Name:VARICOSE VEIN CLINIC - NORTHWEST, P.A.
Entity type:Organization
Organization Name:VARICOSE VEIN CLINIC - NORTHWEST, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-7467
Mailing Address - Street 1:4330 MEDICAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3353
Mailing Address - Country:US
Mailing Address - Phone:210-614-7467
Mailing Address - Fax:210-614-8666
Practice Address - Street 1:4330 MEDICAL DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3353
Practice Address - Country:US
Practice Address - Phone:210-614-7467
Practice Address - Fax:210-614-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00703NMedicare ID - Type UnspecifiedGROUP ID NUMBER