1609965748 NPI number — COACHELLA DESERT OASIS OB/GYN, MEDICAL ASSOCIATES INC.

Table of content: (NPI 1609965748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609965748 NPI number — COACHELLA DESERT OASIS OB/GYN, MEDICAL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COACHELLA DESERT OASIS OB/GYN, MEDICAL ASSOCIATES INC.
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:
1609965748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92263-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-416-3770
Provider Business Mailing Address Fax Number:
760-322-4596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 N INDIAN CANYON DR
Provider Second Line Business Practice Location Address:
SUITE W-300
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-416-3770
Provider Business Practice Location Address Fax Number:
760-322-4596
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
REYNALDO
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
760-416-3390

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A51395 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: G86746 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GR0090410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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