Healthcare Provider Details

I. General information

NPI: 1316231020
Provider Name (Legal Business Name): DESERT VIEW ENDOSCOPY CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12595 HESPERIA RD SUITE 100
VICTORVILLE CA
92395-5882
US

IV. Provider business mailing address

12565 HESPERIA RD SUITE 1
VICTORVILLE CA
92395-8318
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-5800
  • Fax:
Mailing address:
  • Phone: 760-946-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberBSL11-01505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS NGUYEN
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 760-946-5800