Healthcare Provider Details

I. General information

NPI: 1609064435
Provider Name (Legal Business Name): ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST STE H701
PALM DESERT CA
92211-6103
US

IV. Provider business mailing address

41990 COOK ST STE H701
PALM DESERT CA
92211-6103
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-7900
  • Fax: 760-327-7905
Mailing address:
  • Phone: 760-327-7900
  • Fax: 760-327-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA86905
License Number StateCA

VIII. Authorized Official

Name: JOLYN FERGON
Title or Position: VICE PRESIDENT & CFO
Credential: NP & CNM
Phone: 760-327-7900