Provider Demographics
NPI:1225089014
Name:DESERT HEART CENTER LTD
Entity Type:Organization
Organization Name:DESERT HEART CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-931-4530
Mailing Address - Street 1:3815 E BELL ROAD
Mailing Address - Street 2:SUITE # 3400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2159
Mailing Address - Country:US
Mailing Address - Phone:602-971-2761
Mailing Address - Fax:602-917-1529
Practice Address - Street 1:3815 E BELL ROAD
Practice Address - Street 2:SUITE # 3400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2159
Practice Address - Country:US
Practice Address - Phone:602-971-2761
Practice Address - Fax:602-917-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC43892Medicare UPIN
AZE28409Medicare UPIN