Provider Demographics
NPI:1063655330
Name:DESERT RIDGE SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:DESERT RIDGE SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-320-9755
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:20940 N TATUM BLVD
Practice Address - Street 2:210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4265
Practice Address - Country:US
Practice Address - Phone:480-686-8737
Practice Address - Fax:480-219-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty