Organization Name: | DESERT DERMAESTHETICS, INC. |
NPI Number: | 1144343310 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUTH ELLEN VANDERPLAS (PRESIDENT) |
Mailing Address: | 47647 Caleo Bay Drive Suite 250 La Quinta |
State: | CA US |
Postal Code: | 922539998 |
Phone Number: | 7607777993 |
Fax Number: | 7607774244 |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 11/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A88507 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |