Healthcare Provider Details

I. General information

NPI: 1952186322
Provider Name (Legal Business Name): YUCCA VALLEY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57370 29 PALMS HWY STE 203
YUCCA VALLEY CA
92284-2900
US

IV. Provider business mailing address

57370 29 PALMS HWY STE 203
YUCCA VALLEY CA
92284-2900
US

V. Phone/Fax

Practice location:
  • Phone: 760-369-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI HORNING
Title or Position: CREDENTIALER
Credential:
Phone: 707-299-7043