Healthcare Provider Details

I. General information

NPI: 1134144165
Provider Name (Legal Business Name): DAP HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 YAQUI PASS RD
BORREGO SPRINGS CA
92004-2369
US

IV. Provider business mailing address

1695 N. SUNRISE WAY
PALM SPRINGS CA
92262
US

V. Phone/Fax

Practice location:
  • Phone: 760-767-5051
  • Fax: 760-767-4552
Mailing address:
  • Phone: 760-323-2118
  • Fax: 760-767-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number080000651
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JUDY STITH
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 760-323-2118