Provider Demographics
NPI:1417164070
Name:DESERT MEDICAL GROUP
Entity Type:Organization
Organization Name:DESERT MEDICAL GROUP
Other - Org Name:SAGUNA RAO, MD
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 1:81880 DOCTOR CARREON BLVD STE A103
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5583
Mailing Address - Country:US
Mailing Address - Phone:760-342-2255
Mailing Address - Fax:760-342-2397
Practice Address - Street 1:81880 DOCTOR CARREON BLVD STE A103
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5583
Practice Address - Country:US
Practice Address - Phone:760-342-2255
Practice Address - Fax:760-342-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty