Healthcare Provider Details

I. General information

NPI: 1568666022
Provider Name (Legal Business Name): RAMIN POOYAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE 201
PALM SPRINGS CA
92262-4857
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR STE 201
PALM SPRINGS CA
92262-4857
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4511
  • Fax: 760-416-4513
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number20A11219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: