Provider Demographics
NPI:1518154087
Name:ASSAD U DARAWAL M.D. INC
Entity Type:Organization
Organization Name:ASSAD U DARAWAL M.D. INC
Other - Org Name:ASSAD U DARWAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASSAD
Authorized Official - Middle Name:U
Authorized Official - Last Name:DARAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-342-8005
Mailing Address - Street 1:81893 DR CARREON BLVD
Mailing Address - Street 2:#1
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5592
Mailing Address - Country:US
Mailing Address - Phone:760-342-8005
Mailing Address - Fax:760-342-5451
Practice Address - Street 1:81893 DR CARREON BLVD #1
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5592
Practice Address - Country:US
Practice Address - Phone:760-342-8005
Practice Address - Fax:760-342-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085630Medicaid
CAF71765Medicare UPIN
CAZZZ16893ZMedicare Oscar/Certification