Healthcare Provider Details

I. General information

NPI: 1730477829
Provider Name (Legal Business Name): RAMIN POOYAN DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE 201
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR SUITE 201
PALM SPRINGS CA
92262-4800
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-6511
  • Fax:
Mailing address:
  • Phone: 760-323-6511
  • 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: DR. RAMIN POOYAN
Title or Position: PRESIDENT
Credential: DO
Phone: 760-323-6511