Provider Demographics
NPI:1366633539
Name:DESERT MOUNTAIN OB/GYN, P.C.
Entity Type:Organization
Organization Name:DESERT MOUNTAIN OB/GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIRIKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-585-0804
Mailing Address - Street 1:14220 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3949
Mailing Address - Country:US
Mailing Address - Phone:480-585-0804
Mailing Address - Fax:480-585-0828
Practice Address - Street 1:14220 N NORTHSIGHT BLVD
Practice Address - Street 2:SUITE150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3949
Practice Address - Country:US
Practice Address - Phone:480-585-0804
Practice Address - Fax:480-585-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ489147-001Medicaid
AZZ68704Medicare PIN
AZ489147-001Medicaid