Healthcare Provider Details

I. General information

NPI: 1487645933
Provider Name (Legal Business Name): DESERT MEDICAL GROUP-DESERT SPECIALTY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69844 HIGHWAY 111
RANCHO MIRAGE CA
92270-2849
US

IV. Provider business mailing address

275 N EL CIELO RD
PALM SPRINGS CA
92262-6972
US

V. Phone/Fax

Practice location:
  • Phone: 760-318-4869
  • Fax: 760-320-2725
Mailing address:
  • Phone: 760-320-4122
  • Fax: 760-320-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: HELENE LECLAIR
Title or Position: ADMINISTRATOR
Credential:
Phone: 760-320-4122