Healthcare Provider Details

I. General information

NPI: 1083043988
Provider Name (Legal Business Name): RUPINDER MANN M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72047 DINAH SHORE DR STE C4
RANCHO MIRAGE CA
92270-1783
US

IV. Provider business mailing address

72047 DINAH SHORE DRIVE C-4
RANCHO MIRAGE CA
92270
US

V. Phone/Fax

Practice location:
  • Phone: 760-770-7600
  • Fax:
Mailing address:
  • Phone: 760-770-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA066357
License Number StateCA

VIII. Authorized Official

Name: TERESA RIVERA
Title or Position: OFFICE BILLER
Credential:
Phone: 844-775-9600