Healthcare Provider Details

I. General information

NPI: 1194944736
Provider Name (Legal Business Name): PHILL VICTOR HALAMANDARIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47825 OASIS ST INDIO MENTAL HEALTH CLINIC
INDIO CA
92201-6950
US

IV. Provider business mailing address

47825 OASIS ST INDIO MENTAL HEALTH CLINIC
INDIO CA
92201-6950
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8455
  • Fax: 760-863-8587
Mailing address:
  • Phone: 760-863-8455
  • Fax: 760-863-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG66098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: