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General NPI Number Information
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NPI Number | 1932267556
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Entity Type | Organization
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Legal Business Name | YUCCA VALLEY FAMILY MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6380 SPLIT ROCK AVE
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-2550
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Country | US
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Telephone | 760-367-6028
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Fax | 760-367-2178
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Provider Business Mailing Address
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Address Line | 6380 SPLIT ROCK AVE
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-2550
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Country | US
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Telephone | 760-367-6028
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Fax | 760-367-2178
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Authorized Official
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Title or Position | OWNER
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Name | ELDENE ARNE SMITH
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Credential | M.D.
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Telephone | 760-367-6028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A38944
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License Number State | CA
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