Healthcare Provider Details

I. General information

NPI: 1891188264
Provider Name (Legal Business Name): MAPZAK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73710 ALESSANDRO DR. BLDG A1
PALM DESERT CA
92260
US

IV. Provider business mailing address

PO BOX 2591
PALM DESERT CA
92260
US

V. Phone/Fax

Practice location:
  • Phone: 760-837-0364
  • Fax: 760-837-3843
Mailing address:
  • Phone: 760-837-0364
  • Fax: 760-837-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMARA SULLIVAN
Title or Position: MANAGER
Credential:
Phone: 760-837-0364