05D2135219 CLIA NUMBER - DESERT VEIN AND VASCULAR INSTITUTE

Laboratory Demographics

CLIA Number: 05D2135219

Facility Name: DESERT VEIN AND VASCULAR INSTITUTE

Facility Address:
72120 MAGNESIA FALLS DR, STE C
RANCHO MIRAGE, CA
ZIP 92270
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Facility Phone Number: 760 895-4209

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821415142

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	05D2135219
LAB Type	Physician Office
Facility Name	DESERT VEIN AND VASCULAR INSTITUTE
Street	72120 MAGNESIA FALLS DR, STE C
City	RANCHO MIRAGE
State	CA
ZIP	92270
Phone	760 895-4209
CertificateType	4
CertificateEffectiveDate	8/16/2023
CertificateExpirationDate	8/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024