1619251576 NPI number — DESERT PROSTHETICS & ORTHOTICS GROUP

Table of content: DEBORAH MICHELLE NEW BSN (NPI 1942469549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619251576 NPI number — DESERT PROSTHETICS & ORTHOTICS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT PROSTHETICS & ORTHOTICS GROUP
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:
1619251576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68860 PEREZ ROAD STE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATHEDRAL CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-770-4620
Provider Business Mailing Address Fax Number:
760-770-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57402 TWENTYNINE PALMS HWY
Provider Second Line Business Practice Location Address:
8
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-770-4620
Provider Business Practice Location Address Fax Number:
760-770-4622
Provider Enumeration Date:
10/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-770-4620

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GXC000090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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