Healthcare Provider Details

I. General information

NPI: 1619251576
Provider Name (Legal Business Name): DESERT PROSTHETICS & ORTHOTICS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57402 TWENTYNINE PALMS HWY 8
YUCCA VALLEY CA
92284
US

IV. Provider business mailing address

68860 PEREZ ROAD STE G
CATHEDRAL CITY CA
92234
US

V. Phone/Fax

Practice location:
  • Phone: 760-770-4620
  • Fax: 760-770-4622
Mailing address:
  • Phone: 760-770-4620
  • Fax: 760-770-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. NEAL COLLINS
Title or Position: OWNER
Credential: CPO
Phone: 760-770-4620