Healthcare Provider Details

I. General information

NPI: 1477513745
Provider Name (Legal Business Name): DESERT EAR, NOSE & THROAT MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71687 HIGHWAY 111 STE 101
RANCHO MIRAGE CA
92270-4515
US

IV. Provider business mailing address

71687 HIGHWAY 111 STE 101
RANCHO MIRAGE CA
92270-4515
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-4566
  • Fax: 760-340-2481
Mailing address:
  • Phone: 760-340-4566
  • Fax: 760-340-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER WALZ
Title or Position: PARTNER/DELEGATED OFFICIAL
Credential: M.D.
Phone: 760-340-4566