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General NPI Number Information
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NPI Number | 1588668503
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Entity Type | Organization
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Legal Business Name | MIRAGE ENDOSCOPY CENTER, L.P.
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 70017 HIGHWAY 111 STE 2
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-2999
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Country | US
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Telephone | 760-837-9210
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Fax | 760-837-9232
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Provider Business Mailing Address
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Address Line | 70017 HIGHWAY 111 STE 2
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-2999
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Country | US
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Telephone | 760-837-9210
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Fax | 760-837-9232
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | ANN BRODY
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Credential |
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Telephone | 760-837-9210
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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 | 250000789
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License Number State | CA
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