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General NPI Number Information
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NPI Number | 1316440811
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Entity Type | Organization
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Legal Business Name | PALM VALLEY SURGICAL CENTER, INC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 72650 FRED WARING DR STE 103
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City | PALM DESERT
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State | CA
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Zip | 92260-5007
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Country | US
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Telephone | 760-810-7587
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Fax | 760-810-7593
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Provider Business Mailing Address
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Address Line | 12277 APPLE VALLEY RD PMB 397
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City | APPLE VALLEY
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State | CA
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Zip | 92308-1701
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Country | US
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Telephone | 760-810-7587
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Fax | 760-810-7593
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DIANE MICHELLE SOTO
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Credential |
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Telephone | 760-375-3974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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