Healthcare Provider Details

I. General information

NPI: 1831184191
Provider Name (Legal Business Name): DRUMMOND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N. CHINA LAKE BLVD
RIDGECREST CA
93555-3131
US

IV. Provider business mailing address

1111 N. CHINA LAKE BLVD
RIDGECREST CA
93555-3131
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-8100
  • Fax: 760-446-8181
Mailing address:
  • Phone: 760-446-8100
  • Fax: 760-446-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number120000489
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. D ROBERTS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 760-446-8201