Healthcare Provider Details

I. General information

NPI: 1457302812
Provider Name (Legal Business Name): PREM P SALHOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57725 29 PALMS HWY SUITE 401
YUCCA VALLEY CA
92284-3044
US

IV. Provider business mailing address

PO BOX 1809
YUCCA VALLEY CA
92286-1809
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-1929
  • Fax: 760-228-9633
Mailing address:
  • Phone: 760-228-1929
  • Fax: 760-228-9633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA426710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: