Provider Demographics
NPI:1700363645
Name:DESERT PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:DESERT PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAZARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-863-5955
Mailing Address - Street 1:81765 HIGHWAY 111, STE #3
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-863-5955
Mailing Address - Fax:760-863-5655
Practice Address - Street 1:81765 HIGHWAY 111, STE #3
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-863-5955
Practice Address - Fax:760-863-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6613208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty