MEDICARE: DESERT VIEW MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G60508	CA

General Provider Information

NPI Number	:	1023394285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VIEW MEDICAL

Provider Business Mailing Address
First Line	:	205 N 1ST ST STE A
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1777
Country	:	US
Telephone Number	:	760-921-3474
Fax Number	:	760-921-3471

Provider Business Practice Location Address
First Line	:	205 N 1ST ST STE A
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1777
Country	:	US
Telephone Number	:	760-921-3474
Fax Number	:	760-921-3471

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH G. LUCERO
Credential	:	M.D.
Telephone Number	:	760-921-3468

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	08/05/2013

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Directions to “DESERT VIEW MEDICAL ” Practice Location

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