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NPI Code Detail

MEDICARE: CANYON PALMS SURGERY CENTER, LLC

MEDICARE: CANYON PALMS SURGERY CENTER, LLC
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1023799376
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANYON PALMS SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 72650 FRED WARING DR STE 206
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-5009
Country : US
Telephone Number : 760-793-1789
Fax Number : 760-560-5953
Provider Business Practice Location Address
First Line : 1221 N INDIAN CANYON DR
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262-4875
Country : US
Telephone Number : 760-810-7590
Fax Number :
Authorized Official
Title or Position : BILLING MANAGER
Name : MICHELLE SOTO
Credential :
Telephone Number : 760-793-1789
Provider Enumeration Date : 07/28/2023
Last Update Date : 07/28/2023

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Directions to “CANYON PALMS SURGERY CENTER, LLC ” Practice Location

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