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Organization
MIRAGE MEDICAL GROUP CENTER
Active
Organization
MIRAGE MEDICAL GROUP CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZORAN RUBAKOVICH (ADMINISTRATOR)
(760) 346-4003
Entity
Organization
Contact information
Practice address
44650 VILLAGE CT STE 100, PALM DESERT, CA 92260-3812
(760) 346-4003
(760) 346-4443
Mailing address
44650 VILLAGE CT STE 100, PALM DESERT, CA 92260-3812
(760) 346-4003
(760) 346-4443
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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