Provider Demographics
NPI:1093576068
Name:DESERT MORNING GLORY, INC
Entity Type:Organization
Organization Name:DESERT MORNING GLORY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-216-3244
Mailing Address - Street 1:3000 W MACARTHUR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6982
Mailing Address - Country:US
Mailing Address - Phone:949-216-3244
Mailing Address - Fax:714-564-8306
Practice Address - Street 1:3000 W MACARTHUR BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6982
Practice Address - Country:US
Practice Address - Phone:949-216-3244
Practice Address - Fax:714-564-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811215353Medicaid