1598301764 NPI number — DESERT ORTHOPEDIC CENTER A MEDICAL GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598301764 NPI number — DESERT ORTHOPEDIC CENTER A MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT ORTHOPEDIC CENTER A MEDICAL GROUP 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:
6
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:
1598301764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1730
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-568-2684
Provider Business Mailing Address Fax Number:
760-341-5832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39700 BOB HOPE DR STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-3267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-568-2684
Provider Business Practice Location Address Fax Number:
760-837-2202
Provider Enumeration Date:
11/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DILTZ
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
MD / MEDICAL DIRECTOR / OWNER
Authorized Official Telephone Number:
760-568-2684

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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