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General NPI Number Information
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NPI Number | 1497765424
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Entity Type | Organization
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Legal Business Name | LA QUINTA EAR NOSE & THROAT, INC.
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 78370 HIGHWAY 111 STE 160
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City | LA QUINTA
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State | CA
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Zip | 92253-2623
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Country | US
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Telephone | 760-771-4242
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Fax | 760-691-2952
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Provider Business Mailing Address
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Address Line | PO BOX 6119
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City | LA QUINTA
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State | CA
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Zip | 92248-6119
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Country | US
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Telephone | 760-771-4242
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Fax | 760-771-4294
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. ERIC ANTHONY NASH
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Credential | M.D.
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Telephone | 760-771-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G70770
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License Number State | CA
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