Healthcare Provider Details

I. General information

NPI: 1942278775
Provider Name (Legal Business Name): ERIC L MIZRAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-346-5688
  • Fax: 760-773-3976
Mailing address:
  • Phone: 760-346-5688
  • Fax: 760-773-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG85225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: