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General NPI Number Information
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NPI Number | 1710973466
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Entity Type | Organization
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Legal Business Name | DESERT COMPREHENSIVE UROLOGY
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 72-780 COUNTY CLUB DR. 302-C
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270
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Country | US
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Telephone | 760-346-4299
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Fax | 760-776-4042
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Provider Business Mailing Address
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Address Line | 72-780 COUNTY CLUB DR. 302-C
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270
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Country | US
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Telephone | 760-346-4299
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Fax | 760-776-4042
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Authorized Official
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Title or Position | OWNER
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Name | JOHN R. FAULKNER
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Credential | M.D.
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Telephone | 760-346-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G62490
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License Number State | CA
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