Healthcare Provider Details

I. General information

NPI: 1912979303
Provider Name (Legal Business Name): DESERT ANGELS MEDICAL CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HIGHWAY 95 SUITE 101
BULLHEAD CITY AZ
86442-7802
US

IV. Provider business mailing address

3003 HIGHWAY 95 SUITE 101
BULLHEAD CITY AZ
86442-7802
US

V. Phone/Fax

Practice location:
  • Phone: 928-758-0202
  • Fax: 928-758-2656
Mailing address:
  • Phone: 928-758-0202
  • Fax: 928-758-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA D SALAMATIN
Title or Position: OWNER
Credential: MD
Phone: 928-758-0202