Provider Demographics
NPI:1316231020
Name:DESERT VIEW ENDOSCOPY CENTER, LLC.
Entity Type:Organization
Organization Name:DESERT VIEW ENDOSCOPY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-946-5800
Mailing Address - Street 1:12565 HESPERIA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8318
Mailing Address - Country:US
Mailing Address - Phone:760-946-5800
Mailing Address - Fax:
Practice Address - Street 1:12595 HESPERIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5882
Practice Address - Country:US
Practice Address - Phone:760-946-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABSL11-01505261QA1903X
261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy