Provider Demographics
NPI:1790598381
Name:JERALYN BROSSFIELD M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JERALYN BROSSFIELD M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:769-691-2069
Mailing Address - Street 1:72301 COUNTRY CLUB DR STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-8007
Mailing Address - Country:US
Mailing Address - Phone:760-567-8207
Mailing Address - Fax:
Practice Address - Street 1:72301 COUNTRY CLUB DR STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-8007
Practice Address - Country:US
Practice Address - Phone:760-567-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO64527OtherCA LICENSE NUMBER
CA10943589OtherCAQH