Provider Demographics
NPI:1821415142
Name:DESERT VEIN & VASCULAR INSTITUTE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DESERT VEIN & VASCULAR INSTITUTE PROFESSIONAL CORPORATION
Other - Org Name:EMPIRE VEIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-568-3461
Mailing Address - Street 1:71780 SAN JACINTO DR
Mailing Address - Street 2:BLDG. I
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71780 SAN JACINTO DR
Practice Address - Street 2:BLDG. I
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5516
Practice Address - Country:US
Practice Address - Phone:760-568-3461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800338478Medicaid