Healthcare Provider Details

I. General information

NPI: 1457763989
Provider Name (Legal Business Name): AMBROSIA HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75060 GERALD FORD DR STE 2
PALM DESERT CA
92211-2080
US

IV. Provider business mailing address

PO BOX 10203
PALM DESERT CA
92255-0203
US

V. Phone/Fax

Practice location:
  • Phone: 760-691-2000
  • Fax: 888-505-3006
Mailing address:
  • Phone: 760-691-2000
  • Fax: 888-505-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHY51868
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MANISHKUMAR PATEL
Title or Position: CEO
Credential:
Phone: 760-691-2000