Provider Demographics
NPI:1699666255
Name:SONORAN VEIN AND ENDOVASCULAR LLC
Entity type:Organization
Organization Name:SONORAN VEIN AND ENDOVASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-363-7778
Mailing Address - Street 1:9192 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8208
Mailing Address - Country:US
Mailing Address - Phone:602-374-4101
Mailing Address - Fax:602-441-0522
Practice Address - Street 1:9192 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8208
Practice Address - Country:US
Practice Address - Phone:602-374-4101
Practice Address - Fax:602-441-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical