Provider Demographics
NPI:1619224243
Name:HIGH DESERT PRIMARY CARE
Entity Type:Organization
Organization Name:HIGH DESERT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:EL-HAJJAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-241-6666
Mailing Address - Street 1:17095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6004
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-241-7575
Practice Address - Street 1:19333 BEAR VALLEY RD
Practice Address - Street 2:101
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5148
Practice Address - Country:US
Practice Address - Phone:760-240-3784
Practice Address - Fax:760-247-4368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty