# MIRAGE MEDICAL GROUP CENTER

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

## Provider details

- **NPI number:** 1356811061
- **Authorized official:** ZORAN RUBAKOVICH (ADMINISTRATOR)
- **Authorized official phone:** (760) 346-4003

## Contact information

- **Practice address:** 44650 VILLAGE CT STE 100, PALM DESERT, CA 92260-3812
- **Practice address phone:** (760) 346-4003
- **Practice address fax:** (760) 346-4443
- **Mailing address:** 44650 VILLAGE CT STE 100, PALM DESERT, CA 92260-3812
- **Mailing address phone:** (760) 346-4003
- **Mailing address fax:** (760) 346-4443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/26/2018
- **Last updated:** 11/26/2018