Healthcare Provider Details

I. General information

NPI: 1780835819
Provider Name (Legal Business Name): EISENHOWER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 205
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3221
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7900
  • Fax: 760-834-7901
Mailing address:
  • Phone: 760-340-3911
  • Fax: 760-773-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number250000142
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number250000142
License Number StateCA

VIII. Authorized Official

Name: MARTIN JOSEPH MASSIELLO
Title or Position: PRESIDENT & CEO
Credential:
Phone: 760-773-1228