Healthcare Provider Details

I. General information

NPI: 1023215308
Provider Name (Legal Business Name): DESERT FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81713 HIGHWAY 111 SUITE F
INDIO CA
92201-0000
US

IV. Provider business mailing address

81713 HIGHWAY 111 SUITE F
INDIO CA
92201-0000
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-5355
  • Fax: 760-863-5885
Mailing address:
  • Phone: 760-863-5355
  • Fax: 760-863-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP9223
License Number StateCA

VIII. Authorized Official

Name: MR. JOB LOPEZ
Title or Position: NP
Credential: NP
Phone: 760-863-5355