Healthcare Provider Details

I. General information

NPI: 1710803770
Provider Name (Legal Business Name): EXODUS SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41990 COOK ST STE F1003
PALM DESERT CA
92211-6100
US

IV. Provider business mailing address

79405 HIGHWAY 111 STE 9469
LA QUINTA CA
92253-8300
US

V. Phone/Fax

Practice location:
  • Phone: 760-565-5545
  • Fax: 760-424-5578
Mailing address:
  • Phone: 760-565-5545
  • Fax: 760-424-5578

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: SOPHIA HASE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 760-565-5545