Provider Demographics
NPI:1992946719
Name:PALM SPRINGS OB/GYN
Entity type:Organization
Organization Name:PALM SPRINGS OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-322-3166
Mailing Address - Street 1:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-1886
Mailing Address - Country:US
Mailing Address - Phone:760-322-3166
Mailing Address - Fax:760-322-9309
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-322-3166
Practice Address - Fax:760-322-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97869174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA97869OtherALL NUMBERS ARE CURRENTLY PENDING