Healthcare Provider Details

I. General information

NPI: 1023799376
Provider Name (Legal Business Name): CANYON PALMS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4875
US

IV. Provider business mailing address

72650 FRED WARING DR STE 206
PALM DESERT CA
92260-5009
US

V. Phone/Fax

Practice location:
  • Phone: 760-810-7590
  • Fax:
Mailing address:
  • Phone: 760-793-1789
  • Fax: 760-560-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SOTO
Title or Position: BILLING MANAGER
Credential:
Phone: 760-793-1789