Provider Demographics
NPI:1023215308
Name:DESERT FAMILY CARE
Entity Type:Organization
Organization Name:DESERT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOB
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:760-863-5355
Mailing Address - Street 1:81713 HIGHWAY 111
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0000
Mailing Address - Country:US
Mailing Address - Phone:760-863-5355
Mailing Address - Fax:760-863-5885
Practice Address - Street 1:81713 HIGHWAY 111
Practice Address - Street 2:SUITE F
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-0000
Practice Address - Country:US
Practice Address - Phone:760-863-5355
Practice Address - Fax:760-863-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP09731Medicare UPIN
CAZZZ184962Medicare ID - Type UnspecifiedMEDICARE PROVIDER