| N/a | |
|
44530 San Pablo Ave Suite 204 Palm Desert CA 92260-3596 | |
| (760) 340-1264 | |
| (760) 340-0382 |
| Full Name | N/a |
|---|---|
| Speciality | Internal Medicine |
| Location | 44530 San Pablo Ave, Palm Desert, California |
| Authorized Official Name and Position | William Lee Hathaway (PRESIDENT) |
| Authorized Official Contact | 7603401264 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 44530 San Pablo Ave Suite 204 Palm Desert CA 92260-3596 Ph: (760) 340-1264 | N/a 44530 San Pablo Ave Suite 204 Palm Desert CA 92260-3596 Ph: (760) 340-1264 |
| NPI Number | 1154766566 |
|---|---|
| Provider Enumeration Date | 04/30/2013 |
| Last Update Date | 05/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154766566 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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