Healthcare Provider Details

I. General information

NPI: 1073224085
Provider Name (Legal Business Name): DESERT VASCULAR CENTER A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19111 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

IV. Provider business mailing address

19111 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

V. Phone/Fax

Practice location:
  • Phone: 661-345-3055
  • Fax:
Mailing address:
  • Phone: 626-319-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAHUL NAYYAR
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 613-453-0556