Healthcare Provider Details

I. General information

NPI: 1790598381
Provider Name (Legal Business Name): JERALYN BROSSFIELD M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72301 COUNTRY CLUB DR STE 105
RANCHO MIRAGE CA
92270-8007
US

IV. Provider business mailing address

72301 COUNTRY CLUB DR STE 105
RANCHO MIRAGE CA
92270-8007
US

V. Phone/Fax

Practice location:
  • Phone: 760-567-8207
  • Fax:
Mailing address:
  • Phone: 760-567-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERALYN BROSSFIELD
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 769-691-2069