Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 34172 | AZ |
NPI | 1760472567 |
---|---|
Provider Name | Veena Vanmala Vats |
First Address | Gilbert, AZ 85297-0429 |
Second Address | Gilbert, AZ 85297-0429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 08/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212627 | (05) | AZ |