MEDICARE: ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A86905	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134237993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	41990 COOK ST STE H701
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-6103
Country	:	US
Telephone Number	:	760-327-7900
Fax Number	:	760-327-7905

Provider Business Practice Location Address
First Line	:	1180 N INDIAN CANYON DR STE W300
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4809
Country	:	US
Telephone Number	:	760-327-7900
Fax Number	:	760-327-7905

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MS. JOLYN FERGON
Credential	:	N.P., C.N.M
Telephone Number	:	760-327-7900

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/12/2025

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