Provider Demographics
NPI:1417035239
Name:DESERT MEDICAL GROUP
Entity type:Organization
Organization Name:DESERT MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:760-320-4122
Mailing Address - Street 1:81880 DOCTOR CARREON BLVD STE C108
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5586
Mailing Address - Country:US
Mailing Address - Phone:760-775-9641
Mailing Address - Fax:760-775-9741
Practice Address - Street 1:81880 DOCTOR CARREON BLVD STE C108
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5586
Practice Address - Country:US
Practice Address - Phone:760-775-9641
Practice Address - Fax:760-775-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03287ZMedicare ID - Type Unspecified