Provider Demographics
NPI:1649859687
Name:DESERT STAR HEALTHCARE, LLC
Entity type:Organization
Organization Name:DESERT STAR HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C, CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-219-6646
Mailing Address - Street 1:4855 E BROWN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8007
Mailing Address - Country:US
Mailing Address - Phone:480-219-6646
Mailing Address - Fax:480-219-6647
Practice Address - Street 1:4855 E BROWN RD STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8007
Practice Address - Country:US
Practice Address - Phone:480-219-6646
Practice Address - Fax:480-219-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care