Healthcare Provider Details

I. General information

NPI: 1225956030
Provider Name (Legal Business Name): VRUSHANG BHADRESH SONI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71817 HIGHWAY 111 STE 1
RANCHO MIRAGE CA
92270-4487
US

IV. Provider business mailing address

74401 HOVLEY LN E APT 2121
PALM DESERT CA
92260-1717
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-5155
  • Fax: 760-340-1607
Mailing address:
  • Phone: 562-387-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: