Provider Demographics
NPI:1730435496
Name:HIGH DESERT SPECIALTY GROUP
Entity type:Organization
Organization Name:HIGH DESERT SPECIALTY GROUP
Other - Org Name:<UNAVAIL>
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 1:18031 US HIGHWAY 18
Practice Address - Street 2:SUITE B
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2152
Practice Address - Country:US
Practice Address - Phone:760-242-5708
Practice Address - Fax:760-242-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty