Healthcare Provider Details

I. General information

NPI: 1619174521
Provider Name (Legal Business Name): NATALIE DRIESSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44311 MONTEREY AVE
PALM DESERT CA
92260-2710
US

IV. Provider business mailing address

44311 MONTEREY AVE
PALM DESERT CA
92260-2710
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-6616
  • Fax: 760-773-6618
Mailing address:
  • Phone: 760-773-6616
  • Fax: 760-773-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA106037
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA106037
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA106037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: