Provider Demographics
NPI:1225839871
Name:DESERT INTEGRATIVE HEALTH LLC
Entity type:Organization
Organization Name:DESERT INTEGRATIVE HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-300-0010
Mailing Address - Street 1:2235 E FLAMINGO RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2235 E FLAMINGO RD STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0807
Practice Address - Country:US
Practice Address - Phone:702-493-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty