Provider Demographics
NPI:1164738522
Name:HIGH DESERT SPECIALTY GROUP
Entity Type:Organization
Organization Name:HIGH DESERT SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EL HAJJAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-241-6666
Mailing Address - Street 1:17095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6004
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-947-8436
Practice Address - Street 1:12550 HESPERIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5873
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-241-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty