Provider Demographics
NPI:1073783874
Name:DESERT INSTITUTE OF CLASSICAL HOMEOPATHY
Entity type:Organization
Organization Name:DESERT INSTITUTE OF CLASSICAL HOMEOPATHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-347-7950
Mailing Address - Street 1:2001 W CAMELBACK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-7402
Mailing Address - Country:US
Mailing Address - Phone:602-347-7950
Mailing Address - Fax:
Practice Address - Street 1:2001 W CAMELBACK RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-7402
Practice Address - Country:US
Practice Address - Phone:602-347-7950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67175L00000X
AZ208112084P0800X
AZ3013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23122Medicare PIN