Healthcare Provider Details

I. General information

NPI: 1417035239
Provider Name (Legal Business Name): DESERT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81880 DOCTOR CARREON BLVD STE C108
INDIO CA
92201-5586
US

IV. Provider business mailing address

81880 DOCTOR CARREON BLVD STE C108
INDIO CA
92201-5586
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-9641
  • Fax: 760-775-9741
Mailing address:
  • Phone: 760-775-9641
  • Fax: 760-775-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BRANDON
Title or Position: CREDENTIALS MANAGER
Credential: CPCS
Phone: 760-320-4122