Provider Demographics
NPI:1548689615
Name:DESERT INTEGRATIVE MEDICAL CENTER
Entity type:Organization
Organization Name:DESERT INTEGRATIVE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:Z
Authorized Official - Last Name:IZATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-214-8618
Mailing Address - Street 1:41865 BOARDWALK
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9026
Mailing Address - Country:US
Mailing Address - Phone:760-340-2260
Mailing Address - Fax:760-341-5051
Practice Address - Street 1:41865 BOARDWALK
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9026
Practice Address - Country:US
Practice Address - Phone:760-340-2260
Practice Address - Fax:760-341-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty