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General NPI Number Information
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NPI Number | 1144343310
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Entity Type | Organization
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Legal Business Name | DESERT DERMAESTHETICS, INC.
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 47647 CALEO BAY DRIVE SUITE 250
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City | LA QUINTA
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State | CA
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Zip | 92253-9998
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Country | US
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Telephone | 760-777-7993
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Fax | 760-777-4244
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Provider Business Mailing Address
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Address Line | 47647 CALEO BAY DRIVE SUITE 250
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City | LA QUINTA
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State | CA
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Zip | 92253-9998
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Country | US
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Telephone | 760-777-7993
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Fax | 760-777-4244
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUTH ELLEN VANDERPLAS
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Credential | MD
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Telephone | 760-777-7993
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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 | A88507
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A88507
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License Number State | CA
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