Healthcare Provider Details

I. General information

NPI: 1093795320
Provider Name (Legal Business Name): FOOT ANKLE ASSOCIATED OF THE DESERT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82013 DR CARREON BLVD
INDIO CA
92201-5832
US

IV. Provider business mailing address

82013 DR CARREON BLVD
INDIO CA
92201-5832
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-0048
  • Fax:
Mailing address:
  • Phone: 760-863-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN EDWARD EBAUGH
Title or Position: PODIATRY
Credential: DPM
Phone: 760-863-0070