Provider Demographics
NPI:1770537466
Name:HIGH DESERT PRIMARY CARE
Entity type:Organization
Organization Name:HIGH DESERT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-HAJJAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-241-6666
Mailing Address - Street 1:12550 HESPERIA RD
Mailing Address - Street 2:STE 100
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5873
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-951-1609
Practice Address - Street 1:12550 HESPERIA RD
Practice Address - Street 2:STE 100
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5873
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-951-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13501ZOtherMEDICARE PTAN
CAZZZ13501ZMedicare PIN
CACE7126Medicare PIN