Healthcare Provider Details

I. General information

NPI: 1417164070
Provider Name (Legal Business Name): DESERT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81880 DOCTOR CARREON BLVD STE A103
INDIO CA
92201-5583
US

IV. Provider business mailing address

81880 DOCTOR CARREON BLVD STE A103
INDIO CA
92201-5583
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-2255
  • Fax: 760-342-2397
Mailing address:
  • Phone: 760-342-2255
  • Fax: 760-342-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE A BRANDON
Title or Position: CREDENTIALS MANAGER
Credential: CPCS
Phone: 760-320-4122