Provider Demographics
NPI:1609965748
Name:COACHELLA DESERT OASIS OB/GYN, MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:COACHELLA DESERT OASIS OB/GYN, MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:O
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-416-3390
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2165
Mailing Address - Country:US
Mailing Address - Phone:760-416-3770
Mailing Address - Fax:760-322-4596
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE W-300
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-416-3770
Practice Address - Fax:760-322-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51395174400000X
CAG86746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090410Medicaid
CAZZZ21616ZMedicare ID - Type Unspecified
CAF51011Medicare UPIN
CAGR0090410Medicaid