Provider Demographics
NPI:1831623339
Name:WORLD GYM OF PALM DESERT LLC
Entity type:Organization
Organization Name:WORLD GYM OF PALM DESERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATRANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-774-5880
Mailing Address - Street 1:41651 CORPORATE WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-1987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41651 CORPORATE WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1987
Practice Address - Country:US
Practice Address - Phone:760-774-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty