Provider Demographics
NPI:1861176307
Name:DESERT REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:DESERT REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR NEUROLOGY
Authorized Official - Prefix:
Authorized Official - First Name:LATIFA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUKARROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-402-6255
Mailing Address - Street 1:9313 NATIONAL BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2945
Mailing Address - Country:US
Mailing Address - Phone:213-568-8195
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty