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General NPI Number Information
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NPI Number | 1053670372
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Entity Type | Organization
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Legal Business Name | H DAVID SACKS DO A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 44751 VILLAGE CT SUITE 300
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City | PALM DESERT
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State | CA
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Zip | 92260-3815
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Country | US
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Telephone | 760-779-9100
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Fax | 760-779-8202
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Provider Business Mailing Address
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Address Line | 44751 VILLAGE CT SUITE 300
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City | PALM DESERT
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State | CA
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Zip | 92260-3815
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Country | US
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Telephone | 760-779-9100
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Fax | 760-779-8202
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HYMAN DAVID SACKS
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Credential | DO
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Telephone | 760-779-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 20A4920
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License Number State | CA
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