Healthcare Provider Details

I. General information

NPI: 1780863001
Provider Name (Legal Business Name): INTERNAL MEDICINE SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR SUITE 100
RANCHO MIRAGE CA
92270-4126
US

IV. Provider business mailing address

PO BOX 2366
RANCHO MIRAGE CA
92270-1086
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-9750
  • Fax: 760-773-9294
Mailing address:
  • Phone: 760-773-9750
  • Fax: 760-773-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS LOPEZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 760-773-9750