Healthcare Provider Details

I. General information

NPI: 1346830783
Provider Name (Legal Business Name): DESERT DX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 N ALTA VISTA BLVD
LOS ANGELES CA
90046-7602
US

IV. Provider business mailing address

157 OCEAN PARK BLVD
SANTA MONICA CA
90405-3525
US

V. Phone/Fax

Practice location:
  • Phone: 213-999-0896
  • Fax:
Mailing address:
  • Phone: 213-999-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MAX MCNALLY
Title or Position: CEO
Credential: BSC
Phone: 213-999-0896