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General NPI Number Information
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NPI Number | 1932342227
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Entity Type | Organization
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Legal Business Name | MIRAGE ON CALL MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 39000 BOB HOPE DR PROBST BUILDING, SUITE 308
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3221
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Country | US
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Telephone | 760-346-5688
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Fax |
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Provider Business Mailing Address
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Address Line | 39000 BOB HOPE DR PROBST BUILDING, SUITE 308
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3221
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Country | US
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Telephone | 760-346-5688
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | DR. SOLMAZ B AZAR
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Credential | M.D.
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Telephone | 760-346-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | A102790
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License Number State | CA
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