Healthcare Provider Details

I. General information

NPI: 1215877220
Provider Name (Legal Business Name): HEALTH CENTER MSO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36101 BOB HOPE DR STE E2
RANCHO MIRAGE CA
92270-2006
US

IV. Provider business mailing address

36101 BOB HOPE DR STE E2
RANCHO MIRAGE CA
92270-2006
US

V. Phone/Fax

Practice location:
  • Phone: 833-649-4628
  • Fax: 833-649-4628
Mailing address:
  • Phone: 833-649-4628
  • Fax: 833-649-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD VEZINA
Title or Position: DIRECTOR
Credential: DR
Phone: 833-649-4628