Healthcare Provider Details

I. General information

NPI: 1083614929
Provider Name (Legal Business Name): DESERT MEDICAL IMAGING, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 N PALM CANYON DR STE B
PALM SPRINGS CA
92262-4401
US

IV. Provider business mailing address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7128
US

V. Phone/Fax

Practice location:
  • Phone: 760-322-8883
  • Fax: 760-325-2037
Mailing address:
  • Phone: 760-776-8989
  • Fax: 760-779-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberFNP25453
License Number StateCA

VIII. Authorized Official

Name: CORY HAMMOND
Title or Position: CFO
Credential:
Phone: 760-776-8989