Provider Demographics
NPI:1891079745
Name:DESERT WOMENS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DESERT WOMENS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:COOPER VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MDFACOG
Authorized Official - Phone:760-320-1805
Mailing Address - Street 1:PO BOX 2974
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2974
Mailing Address - Country:US
Mailing Address - Phone:760-320-1805
Mailing Address - Fax:760-320-1805
Practice Address - Street 1:9 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6118
Practice Address - Country:US
Practice Address - Phone:760-320-1805
Practice Address - Fax:760-320-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty