Healthcare Provider Details

I. General information

NPI: 1588967962
Provider Name (Legal Business Name): DESERT PROSTHETICS & ORTHOTICS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81709 DR CARREON BLVD SUITE D2
INDIO CA
92201-5509
US

IV. Provider business mailing address

68860 PEREZ RD SUITE G
CATHEDRAL CITY CA
92234-7249
US

V. Phone/Fax

Practice location:
  • Phone: 760-770-4620
  • Fax: 760-770-4622
Mailing address:
  • Phone: 760-770-4620
  • Fax: 760-770-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSEMARIE RODRIGUEZ
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 760-770-4620