# CENTRAL DESERT INDUSTRIAL MEDICAL GROUP A PROFESSIONAL CORPORATION

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

## Provider details

- **NPI number:** 1518293356
- **Authorized official:** MS. GWENDOLYN GROVE (EXECUTIVE OPERATIONS DIRECTOR)
- **Authorized official phone:** (760) 242-7003

## Contact information

- **Practice address:** 18031 US HIGHWAY 18, SUITE F, APPLE VALLEY, CA 92307-2152
- **Practice address phone:** (760) 242-7003
- **Practice address fax:** (730) 242-7703
- **Mailing address:** 18031 US HIGHWAY 18, SUITE F, APPLE VALLEY, CA 92307-2152
- **Mailing address phone:** (760) 242-7003
- **Mailing address fax:** (730) 242-7703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | 12656PA | CA | — |
| 261QX0100X | Occupational Medicine Clinic/Center | 20A5179 | CA | Yes |

## Other

- **Enumeration date:** 10/29/2009
- **Last updated:** 08/31/2012