Healthcare Provider Details

I. General information

NPI: 1679508774
Provider Name (Legal Business Name): DESERT REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E. TACHEVAH 3E-101
PALM SPRINGS CA
92262-5749
US

IV. Provider business mailing address

PO BOX 57154
LOS ANGELES CA
90074-7154
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-6511
  • Fax:
Mailing address:
  • Phone: 760-323-6492
  • Fax: 760-864-9577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number250000139
License Number StateCA

VIII. Authorized Official

Name: JIMMY FISH
Title or Position: CFO
Credential:
Phone: 760-323-6483