Provider Demographics
NPI:1982982492
Name:DESERT SPINE SPORT & JOINT CENTER
Entity Type:Organization
Organization Name:DESERT SPINE SPORT & JOINT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-340-1003
Mailing Address - Street 1:36915 COOK ST
Mailing Address - Street 2:103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6067
Mailing Address - Country:US
Mailing Address - Phone:760-340-1003
Mailing Address - Fax:760-340-4844
Practice Address - Street 1:36915 COOK ST
Practice Address - Street 2:103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6067
Practice Address - Country:US
Practice Address - Phone:760-340-1003
Practice Address - Fax:760-340-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6634710001Medicare NSC