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General NPI Number Information
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NPI Number | 1942659099
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Entity Type | Organization
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Legal Business Name | 29 PALMS SURGERY CENTER INCORPORATED
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 73666 JOSHUA DR
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-2572
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Country | US
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Telephone | 760-865-0544
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Fax | 888-877-5510
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Provider Business Mailing Address
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Address Line | 73666 JOSHUA DR
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City | TWENTYNINE PALMS
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State | CA
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Zip | 92277-2572
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Country | US
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Telephone | 760-865-0544
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Fax | 888-877-5510
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Authorized Official
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Title or Position | OWNER
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Name | AN V NGUYEN
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Credential | DDS
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Telephone | 760-865-0544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 56731
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 56731
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 56731
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 56731
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License Number State | CA
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