Healthcare Provider Details

I. General information

NPI: 1669544730
Provider Name (Legal Business Name): DESERT FAMILY PRACTICE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9275 SKY PARK CT STE 400
SAN DIEGO CA
92123-4386
US

IV. Provider business mailing address

9275 SKY PARK CT STE 400
SAN DIEGO CA
92123-4386
US

V. Phone/Fax

Practice location:
  • Phone: 858-467-7640
  • Fax: 858-467-7649
Mailing address:
  • Phone: 858-467-7640
  • Fax: 858-467-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA HERNANDEZ
Title or Position: ASSOC VP OF OPERATIONS
Credential:
Phone: 858-467-7640