Provider Demographics
NPI:1881960920
Name:WEST HOLLYWOOD VEIN CLINIC PC
Entity type:Organization
Organization Name:WEST HOLLYWOOD VEIN CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-593-8616
Mailing Address - Street 1:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0832
Mailing Address - Country:US
Mailing Address - Phone:323-798-1800
Mailing Address - Fax:323-798-1801
Practice Address - Street 1:7901 SANTA MONICA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5180
Practice Address - Country:US
Practice Address - Phone:323-798-1800
Practice Address - Fax:323-798-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty