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General NPI Number Information
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NPI Number | 1114056538
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Entity Type | Organization
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Legal Business Name | SAIRWAA T. PREVOST, M.D., INC.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 35400 BOB HOPE DR SUITE 107
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1772
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Country | US
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Telephone | 646-489-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E TAHQUITZ CANYON WAY ROOM 323
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City | PALM SPRINGS
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State | CA
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Zip | 92262-6722
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Country | US
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Telephone | 646-489-2212
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SAIRWAA TANDEE PREVOST
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Credential | M.D.
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Telephone | 646-489-3312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C51315
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License Number State | CA
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