Healthcare Provider Details

I. General information

NPI: 1184043119
Provider Name (Legal Business Name): DESERT ROSE FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 ARDMORE RD
WEST PALM BEACH FL
33401-7631
US

IV. Provider business mailing address

1095 MILITARY TRL UNIT 91
JUPITER FL
33468-5005
US

V. Phone/Fax

Practice location:
  • Phone: 561-352-0278
  • Fax:
Mailing address:
  • Phone: 561-748-2889
  • Fax: 561-748-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JANE LAPIS
Title or Position: BILLING MANAGER
Credential:
Phone: 561-748-2889