MEDICARE: DESERT FAMILY PRACTICE ASSOCIATES

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	1486	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255383188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT FAMILY PRACTICE ASSOCIATES

Provider Business Mailing Address
First Line	:	11919 HESPERIA RD
Second Line	:	SUITE A
City	:	HESPERIA
State	:	CA
Zip	:	92345-1855
Country	:	US
Telephone Number	:	760-948-1454
Fax Number	:	760-948-6100

Provider Business Practice Location Address
First Line	:	11919 HESPERIA RD
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-1855
Country	:	US
Telephone Number	:	760-948-1454
Fax Number	:	760-948-6100

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MICHAEL J VIZCARRA
Credential	:	M.D.
Telephone Number	:	760-948-1454

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/05/2015

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