# DR TED Y FISHER A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Desert Vein Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235593260
- **Authorized official:** DR. TED YOSHIO FISHER MD (PRESIDENT)
- **Authorized official phone:** (972) 822-1957

## Contact information

- **Practice address:** 628 G ST, BRAWLEY, CA 92227-2544
- **Practice address phone:** (760) 344-1101
- **Practice address fax:** (760) 344-4985
- **Mailing address:** 628 G STREET, BRAWLEY, CA 92227
- **Mailing address phone:** (760) 344-1101
- **Mailing address fax:** (760) 344-4985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A52523 | CA | Yes |

## Other

- **Enumeration date:** 04/06/2016
- **Last updated:** 05/19/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00220G | — | TX |