Healthcare Provider Details

I. General information

NPI: 1013014752
Provider Name (Legal Business Name): HARRY LIFSCHUTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81709 DR CARREON BLVD STE D1
INDIO CA
92201-5578
US

IV. Provider business mailing address

14120 ALONDRA BLVD SUITE C
SANTA FE SPRINGS CA
90670-5820
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-3001
  • Fax: 760-775-3115
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG42802
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG42802
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG42802
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG42802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: