Provider Demographics
NPI:1952305880
Name:VERGHESE, VINITA E (MD)
Entity Type:Individual
Prefix:MS
First Name:VINITA
Middle Name:E
Last Name:VERGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR STE P308
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-7054
Mailing Address - Country:US
Mailing Address - Phone:760-346-5688
Mailing Address - Fax:760-773-3976
Practice Address - Street 1:39000 BOB HOPE DR STE P308
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-346-5688
Practice Address - Fax:760-773-3976
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G754230Medicaid
CAE77895Medicare UPIN
CAE77895Medicare UPIN