Provider Demographics
NPI:1235309113
Name:DESERT VALLEY FAMILY PRACTICE
Entity Type:Organization
Organization Name:DESERT VALLEY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-882-0777
Mailing Address - Street 1:1001 MOUNTAIN ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3822
Mailing Address - Country:US
Mailing Address - Phone:775-882-0777
Mailing Address - Fax:775-882-3472
Practice Address - Street 1:1001 MOUNTAIN ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3822
Practice Address - Country:US
Practice Address - Phone:775-882-0777
Practice Address - Fax:775-882-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty