Healthcare Provider Details

I. General information

NPI: 1295031052
Provider Name (Legal Business Name): DESERT VALLEY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19181 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

IV. Provider business mailing address

16850 BEAR VALLEY RD
VICTORVILLE CA
92395-5794
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-8000
  • Fax: 760-962-8021
Mailing address:
  • Phone: 760-241-8000
  • Fax: 760-962-8021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KAVITHA BHATIA
Title or Position: OWNER
Credential: MD
Phone: 760-241-8000