Healthcare Provider Details

I. General information

NPI: 1710190095
Provider Name (Legal Business Name): SANJAY VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
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: 877-673-4670
Mailing address:
  • Phone: 760-984-0003
  • Fax: 877-673-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA105189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA105189
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA105189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: