Provider Demographics
NPI:1972559102
Name:WARREN, JOAN LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LEIGH
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74361 HIGHWAY 111
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4124
Mailing Address - Country:US
Mailing Address - Phone:760-610-5573
Mailing Address - Fax:760-610-5601
Practice Address - Street 1:74361 HIGHWAY 111
Practice Address - Street 2:SUITE 5
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4124
Practice Address - Country:US
Practice Address - Phone:760-610-5573
Practice Address - Fax:760-610-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist