Provider Demographics
NPI:1588967962
Name:DESERT PROSTHETICS & ORTHOTICS GROUP
Entity type:Organization
Organization Name:DESERT PROSTHETICS & ORTHOTICS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-770-4620
Mailing Address - Street 1:68860 PEREZ RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7249
Mailing Address - Country:US
Mailing Address - Phone:760-770-4620
Mailing Address - Fax:760-770-4622
Practice Address - Street 1:81709 DR CARREON BLVD
Practice Address - Street 2:SUITE D2
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5509
Practice Address - Country:US
Practice Address - Phone:760-770-4620
Practice Address - Fax:760-770-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4223120001Medicare NSC