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Organization
MIRAGE CENTER OUTPATIENT SURGERY
Active
Organization
MIRAGE CENTER OUTPATIENT SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTYN MAWBY (ADMIN/OR SUPERVISOR)
(760) 485-9636
Entity
Organization
Contact information
Practice address
39935 VISTA DEL SOL STE 101, RANCHO MIRAGE, CA 92270-3211
(760) 413-8182
Mailing address
39935 VISTA DEL SOL STE 206, RANCHO MIRAGE, CA 92270-3211
(760) 413-8182
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
06/24/2025
Last updated
06/24/2025
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