Healthcare Provider Details

I. General information

NPI: 1841725801
Provider Name (Legal Business Name): THE ORIGINAL VEIN DOCTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44300 MONTEREY AVE SUITE B
PALM DESERT CA
92260-3377
US

IV. Provider business mailing address

44300 MONTEREY AVE SUITE B
PALM DESERT CA
92260-3377
US

V. Phone/Fax

Practice location:
  • Phone: 760-341-5777
  • Fax: 760-340-4184
Mailing address:
  • Phone: 760-341-5777
  • Fax: 760-340-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANFORD JOSEPH GREENBERG
Title or Position: PHYSICIAN
Credential: MD
Phone: 760-341-5777