Provider Demographics
NPI:1124411400
Name:CSI PHYSICAN & MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:CSI PHYSICAN & MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-837-0364
Mailing Address - Street 1:P.O. BOX 533
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260
Mailing Address - Country:US
Mailing Address - Phone:760-837-0364
Mailing Address - Fax:760-837-3843
Practice Address - Street 1:73710 ALESSANDRO DR.
Practice Address - Street 2:BLD CT A1
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:760-837-0364
Practice Address - Fax:760-837-3843
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZAK MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61113261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical