Provider Demographics
NPI:1962154500
Name:FENIX VASCULAR LLC
Entity type:Organization
Organization Name:FENIX VASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR, MD, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-703-5255
Mailing Address - Street 1:4835 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6548
Mailing Address - Country:US
Mailing Address - Phone:713-703-5255
Mailing Address - Fax:954-908-1278
Practice Address - Street 1:4835 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6548
Practice Address - Country:US
Practice Address - Phone:713-703-5255
Practice Address - Fax:954-908-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty