1467394825 NPI number — DESERT WELLNESS NON MEDICAL GROUP LLC

Table of content: (NPI 1467394825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467394825 NPI number — DESERT WELLNESS NON MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT WELLNESS NON MEDICAL GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467394825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 W BROADWAY
Provider Second Line Business Mailing Address:
700-100A PMB 70224
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92101-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
442-230-6492
Provider Business Mailing Address Fax Number:
760-406-5993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2390 N TRAIL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-716-2562
Provider Business Practice Location Address Fax Number:
760-406-5993
Provider Enumeration Date:
04/07/2026

Additional Information

Authorized Official

Authorized Official Last Name:
HIERS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
442-230-6492

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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