Provider Demographics
NPI:1942659099
Name:29 PALMS SURGERY CENTER INCORPORATED
Entity Type:Organization
Organization Name:29 PALMS SURGERY CENTER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AN
Authorized Official - Middle Name:V
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-865-0544
Mailing Address - Street 1:73666 JOSHUA DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2572
Mailing Address - Country:US
Mailing Address - Phone:760-865-0544
Mailing Address - Fax:888-877-5510
Practice Address - Street 1:73666 JOSHUA DR
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2572
Practice Address - Country:US
Practice Address - Phone:760-865-0544
Practice Address - Fax:888-877-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56731261QA1903X, 261QE0002X, 261QP3300X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic