MEDICARE: JOSEPH MITCHELL DAHMAN FNP-C

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	363LF0000X	Family Nurse Practitioner	12786	CA

General Provider Information

NPI Number	:	1376592097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MITCHELL DAHMAN FNP-C

Provider Business Mailing Address
First Line	:	39000 BOB HOPE DR
Second Line	:	LCCC 2ND FLOOR
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-3221
Country	:	US
Telephone Number	:	760-773-1451
Fax Number	:	760-773-1239

Provider Business Practice Location Address
First Line	:	12520 PALM DR
Second Line	:
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-4559
Country	:	US
Telephone Number	:	760-676-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/21/2015

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