Provider Demographics
NPI:1962707984
Name:LAS PALMAS OB GYN INC
Entity type:Organization
Organization Name:LAS PALMAS OB GYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-610-8985
Mailing Address - Street 1:72027 HIGHWAY 111
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4961
Mailing Address - Country:US
Mailing Address - Phone:760-610-8985
Mailing Address - Fax:760-610-8998
Practice Address - Street 1:72027 HIGHWAY 111
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4961
Practice Address - Country:US
Practice Address - Phone:760-610-8985
Practice Address - Fax:760-610-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ89650ZOtherMEDICARE PTAN