Provider Demographics
NPI:1790271393
Name:DESERT PODIATRIST CENTER INC
Entity Type:Organization
Organization Name:DESERT PODIATRIST CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-618-9285
Mailing Address - Street 1:801 E BIRCH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-5925
Mailing Address - Country:US
Mailing Address - Phone:760-618-9285
Mailing Address - Fax:760-618-9240
Practice Address - Street 1:801 E BIRCH ST STE 2
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-5925
Practice Address - Country:US
Practice Address - Phone:760-618-9285
Practice Address - Fax:760-618-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric