Healthcare Provider Details

I. General information

NPI: 1144343310
Provider Name (Legal Business Name): DESERT DERMAESTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47647 CALEO BAY DRIVE SUITE 250
LA QUINTA CA
92253-9998
US

IV. Provider business mailing address

47647 CALEO BAY DRIVE SUITE 250
LA QUINTA CA
92253-9998
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7993
  • Fax: 760-777-4244
Mailing address:
  • Phone: 760-777-7993
  • Fax: 760-777-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA88507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA88507
License Number StateCA

VIII. Authorized Official

Name: DR. RUTH ELLEN VANDERPLAS
Title or Position: PRESIDENT
Credential: MD
Phone: 760-777-7993