Provider Demographics
NPI:1851141139
Name:HIGH DESERT INTERNAL MEDICINE
Entity Type:Organization
Organization Name:HIGH DESERT INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JHAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-813-6851
Mailing Address - Street 1:11133 MARTINGALE WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-1818
Mailing Address - Country:US
Mailing Address - Phone:805-813-6851
Mailing Address - Fax:
Practice Address - Street 1:12765 MAIN ST STE 630
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9134
Practice Address - Country:US
Practice Address - Phone:760-995-2099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty