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General NPI Number Information
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NPI Number | 1255587630
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Entity Type | Organization
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Legal Business Name | DERAKHSH FOZOUNI M.D. OB/GYN & ASSOCIATES A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 555 E TACHEVAH DR SUITE 2W-103
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5750
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Country | US
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Telephone | 760-327-2707
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Fax | 760-778-3780
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Provider Business Mailing Address
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Address Line | PO BOX 2462
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City | PALM SPRINGS
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State | CA
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Zip | 92263-2462
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Country | US
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Telephone | 760-327-2707
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DERAKHSH FOZOUNI
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Credential | M.D.
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Telephone | 760-668-0858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A101294
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A95051
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License Number State | CA
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