Provider Demographics
NPI:1720497928
Name:COLLEGE OF THE DESERT
Entity Type:Organization
Organization Name:COLLEGE OF THE DESERT
Other - Org Name:COD SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-773-2586
Mailing Address - Street 1:5050 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3995
Mailing Address - Country:US
Mailing Address - Phone:800-555-9073
Mailing Address - Fax:972-367-3452
Practice Address - Street 1:43500 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9305
Practice Address - Country:US
Practice Address - Phone:760-773-2586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health