Provider Demographics
NPI:1639771017
Name:ST MARTIN HIGH DESERT
Entity type:Organization
Organization Name:ST MARTIN HIGH DESERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-255-4992
Mailing Address - Street 1:15475 SENECA RD STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2299
Mailing Address - Country:US
Mailing Address - Phone:760-881-9794
Mailing Address - Fax:
Practice Address - Street 1:15475 SENECA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2299
Practice Address - Country:US
Practice Address - Phone:442-255-4992
Practice Address - Fax:442-255-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based