Healthcare Provider Details

I. General information

NPI: 1700643186
Provider Name (Legal Business Name): SANJAY VERMA, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79200 CORPORATE CENTER DR STE 101
LA QUINTA CA
92253-7245
US

IV. Provider business mailing address

79125 CORPORATE CENTER DR UNIT 5157
LA QUINTA CA
92248-4009
US

V. Phone/Fax

Practice location:
  • Phone: 760-984-0003
  • Fax: 442-300-2135
Mailing address:
  • Phone: 760-984-0003
  • Fax: 877-673-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJAY VERMA
Title or Position: PRESIDENT / CEO
Credential:
Phone: 760-984-0003