Provider Demographics
NPI:1598038937
Name:DESERT SPINE AND NEUROSURGICAL INSTITUTE, INC
Entity Type:Organization
Organization Name:DESERT SPINE AND NEUROSURGICAL INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-346-8058
Mailing Address - Street 1:44489 TOWN CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2723
Mailing Address - Country:US
Mailing Address - Phone:760-346-8058
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE A104
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-346-8058
Practice Address - Fax:760-834-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty