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58457 29 Palms Hwy Ste 200 Yucca Valley CA 92284-5879 | |
| (760) 228-1813 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 58457 29 Palms Hwy Ste 200, Yucca Valley, California |
| Authorized Official Name and Position | Madhusudhan Gupta (OWNER) |
| Authorized Official Contact | 7602281813 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
58457 29 Palms Hwy Ste 200 Yucca Valley CA 92284-5879 Ph: (760) 228-1813 | 58457 29 Palms Hwy Ste 200 Yucca Valley CA 92284-5879 Ph: (760) 228-1813 |
| NPI Number | 1730350521 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 03/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730350521 | NPI | - | NPPES |
| ZZZ52542Z | Other | CA | BLUE SHIELD |
| GR0071781 | Medicaid | CA |
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