Healthcare Provider Details

I. General information

NPI: 1255511630
Provider Name (Legal Business Name): FAMILY HEALTH CENTER OF JOSHUA TREE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57445 29 PALMS HWY STE 302
YUCCA VALLEY CA
92284-2947
US

IV. Provider business mailing address

PO BOX 1220
JOSHUA TREE CA
92252-0810
US

V. Phone/Fax

Practice location:
  • Phone: 760-366-7555
  • Fax: 760-366-0529
Mailing address:
  • Phone: 760-366-7555
  • Fax: 760-366-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA MOORE
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 530-340-5406