Provider Demographics
NPI:1558938019
Name:DESERT DIABETES CARE AND EDUCATION
Entity Type:Organization
Organization Name:DESERT DIABETES CARE AND EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAHOUSSAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-532-6054
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1420
Mailing Address - Country:US
Mailing Address - Phone:575-532-6054
Mailing Address - Fax:575-532-0215
Practice Address - Street 1:3530 FOOTHILLS RD
Practice Address - Street 2:SUITE N
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-3626
Practice Address - Country:US
Practice Address - Phone:575-532-6054
Practice Address - Fax:575-532-0215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHABILITATION & OCCUPATIONAL MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty