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44530 San Pablo Ave Suite 204 Palm Desert CA 92260-3596 | |
(760) 340-1264 | |
(760) 340-0382 |
Full Name | |
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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 |
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44530 San Pablo Ave Suite 204 Palm Desert CA 92260-3596 Ph: (760) 340-1264 | 44530 San Pablo Ave Suite 204 Palm Desert CA 92260-3596 Ph: (760) 340-1264 |
NPI Number | 1154766566 |
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Provider Enumeration Date | 04/30/2013 |
Last Update Date | 05/14/2015 |
Identifier | Type | State | Issuer |
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1154766566 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Faculty Physicians And Surgeons Of Llusm Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 41865 Boardwalk, Suite 103, Palm Desert, CA 92211 Phone: 760-341-5570 Fax: 909-558-3905 | |
Jitka Civrna Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74000 Country Club Dr Ste G2, Palm Desert, CA 92260 Phone: 760-773-4948 Fax: 760-773-4910 | |