MEDICARE: DESERT ANGELS MEDICAL CLINIC PLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1912979303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT ANGELS MEDICAL CLINIC PLC

Provider Business Mailing Address
First Line	:	3003 HIGHWAY 95
Second Line	:	SUITE 101
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7802
Country	:	US
Telephone Number	:	928-758-0202
Fax Number	:	928-758-2656

Provider Business Practice Location Address
First Line	:	3003 HIGHWAY 95
Second Line	:	SUITE 101
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7802
Country	:	US
Telephone Number	:	928-758-0202
Fax Number	:	928-758-2656

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA D SALAMATIN
Credential	:	MD
Telephone Number	:	928-758-0202

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	12/28/2007

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