Provider Demographics
NPI:1558521963
Name:DESERT MEDICAL ADVANCES DMA OF THE COACHELLA VALLEY MEDICAL CORPORATIO
Entity Type:Organization
Organization Name:DESERT MEDICAL ADVANCES DMA OF THE COACHELLA VALLEY MEDICAL CORPORATIO
Other - Org Name:MARIA W. GREENWALD, M. D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-9638
Mailing Address - Street 1:69730 HIGHWAY 111 STE 101
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2873
Mailing Address - Country:US
Mailing Address - Phone:760-341-9638
Mailing Address - Fax:760-341-9872
Practice Address - Street 1:69730 HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2873
Practice Address - Country:US
Practice Address - Phone:760-341-9638
Practice Address - Fax:760-341-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51363Medicare UPIN
CA00G494220Medicare PIN