Healthcare Provider Details

I. General information

NPI: 1619814373
Provider Name (Legal Business Name): DESERT SPEECH THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71780 SAN JACINTO DR
RANCHO MIRAGE CA
92270-5516
US

IV. Provider business mailing address

71780 SAN JACINTO DR
RANCHO MIRAGE CA
92270-5516
US

V. Phone/Fax

Practice location:
  • Phone: 442-933-9152
  • Fax:
Mailing address:
  • Phone: 442-933-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: OKSANA DERDERIAN
Title or Position: OWNER
Credential: MS
Phone: 917-547-6767