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General NPI Number Information
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NPI Number | 1992946719
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Entity Type | Organization
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Legal Business Name | PALM SPRINGS OB/GYN
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 1100 N PALM CANYON DR SUITE 107
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4414
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Country | US
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Telephone | 760-322-3166
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Fax | 760-322-9309
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Provider Business Mailing Address
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Address Line | PO BOX 1886
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City | PALM SPRINGS
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State | CA
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Zip | 92263-1886
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Country | US
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Telephone | 760-322-3166
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Fax | 760-322-9309
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Authorized Official
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Title or Position | PRESIDENT/ DIRECTOR
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Name | MS. LISA M BODON
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Credential | M.D.
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Telephone | 760-322-3166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A97869
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License Number State | CA
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