Provider Demographics
NPI:1235345802
Name:DESERT MEDICAL GROUP
Entity Type:Organization
Organization Name:DESERT MEDICAL GROUP
Other - Org Name:LIVING AND AGING WELL YV
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:760-320-4122
Mailing Address - Street 1:56165 29 PALMS HWY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2880
Mailing Address - Country:US
Mailing Address - Phone:760-228-0351
Mailing Address - Fax:760-365-9689
Practice Address - Street 1:56165 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2880
Practice Address - Country:US
Practice Address - Phone:760-228-0351
Practice Address - Fax:760-365-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty