Healthcare Provider Details

I. General information

NPI: 1134475395
Provider Name (Legal Business Name): HIGH DESERT SPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19333 BEAR VALLEY RD SUITE 101
APPLE VALLEY CA
92308-5148
US

IV. Provider business mailing address

17095 MAIN ST
HESPERIA CA
92345-6004
US

V. Phone/Fax

Practice location:
  • Phone: 760-240-6749
  • Fax: 760-956-4156
Mailing address:
  • Phone: 760-956-4133
  • Fax: 760-956-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ZIAD R EL-HAJJAOUI
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 760-241-6666