Healthcare Provider Details

I. General information

NPI: 1336823699
Provider Name (Legal Business Name): DESERT PHYSICAL MEDICINE & PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81765 US HIGHWAY 111 STE 3
INDIO CA
92201-5435
US

IV. Provider business mailing address

38975 SKY CANYON DR STE 107
MURRIETA CA
92563-2676
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-5955
  • Fax:
Mailing address:
  • Phone: 951-327-0918
  • Fax: 951-461-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT LAI
Title or Position: OWNER
Credential: MD
Phone: 760-863-5955