# DESERT BLOOM PLASTIC SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235691510
- **Authorized official:** JORDAN WALLIN MD (PRESIDENT)
- **Authorized official phone:** (435) 627-8150

## Contact information

- **Practice address:** 446 S MALL DR STE 1, ST GEORGE, UT 84790-4944
- **Practice address phone:** (435) 627-8150
- **Mailing address:** 446 S MALL DR STE 1, ST GEORGE, UT 84790-4944
- **Mailing address phone:** (435) 627-8150

## Taxonomy

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

## Other

- **Enumeration date:** 04/04/2019
- **Last updated:** 01/02/2025