Provider Demographics
NPI:1396145991
Name:DESERT MEDICAL CARE & WELLNESS
Entity type:Organization
Organization Name:DESERT MEDICAL CARE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-777-8377
Mailing Address - Street 1:47020 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-6386
Mailing Address - Country:US
Mailing Address - Phone:760-777-8377
Mailing Address - Fax:760-777-9377
Practice Address - Street 1:47020 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253
Practice Address - Country:US
Practice Address - Phone:760-777-8377
Practice Address - Fax:760-777-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7316020001Medicare NSC