Healthcare Provider Details

I. General information

NPI: 1346610052
Provider Name (Legal Business Name): FREDERICK EKO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44651 VILLAGE CT STE 104
PALM DESERT CA
92260-3821
US

IV. Provider business mailing address

PO BOX 2867
PALM DESERT CA
92261-2867
US

V. Phone/Fax

Practice location:
  • Phone: 760-249-2222
  • Fax: 760-237-2223
Mailing address:
  • Phone: 760-249-2222
  • Fax: 760-237-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA120873
License Number StateCA

VIII. Authorized Official

Name: FREDERICK N EKO
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 760-413-5544