Healthcare Provider Details

I. General information

NPI: 1609994037
Provider Name (Legal Business Name): OCCUPATIONAL ORTHOPEDIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82013 DOCTOR CARREON BLVD STE G
INDIO CA
92201-5832
US

IV. Provider business mailing address

31938 TEMECULA PKWY # A337
TEMECULA CA
92592-6810
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-9500
  • Fax: 760-775-9567
Mailing address:
  • Phone: 714-414-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID SCOTT JOHNSON
Title or Position: OWNER
Credential: MD
Phone: 702-283-0085