Provider Demographics
NPI:1497765424
Name:LA QUINTA EAR NOSE & THROAT, INC.
Entity Type:Organization
Organization Name:LA QUINTA EAR NOSE & THROAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-771-4242
Mailing Address - Street 1:PO BOX 6119
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-6119
Mailing Address - Country:US
Mailing Address - Phone:760-771-4242
Mailing Address - Fax:760-771-4294
Practice Address - Street 1:78370 HIGHWAY 111 STE 160
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2623
Practice Address - Country:US
Practice Address - Phone:760-771-4242
Practice Address - Fax:760-691-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538124250OtherNPI FOR ERIC NASH,MD