Provider Demographics
NPI:1154744498
Name:DESERT VASCULAR INSTITUTE, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:DESERT VASCULAR INSTITUTE, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PUNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-836-9005
Mailing Address - Street 1:36955 COOK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6084
Mailing Address - Country:US
Mailing Address - Phone:760-836-9005
Mailing Address - Fax:760-836-9055
Practice Address - Street 1:36955 COOK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6084
Practice Address - Country:US
Practice Address - Phone:760-836-9005
Practice Address - Fax:760-836-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty