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Organization
MIRAGE MEDICAL GROUP
Active
Organization
MIRAGE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ZORAN RUBAKOVICH (DIRECTOR OF OPERATIONS)
(760) 346-4003
Entity
Organization
Contact information
Practice address
69844 HIGHWAY 111 STE K, ONE HAWKEYE PARK, RANCHO MIRAGE, CA 92270-2849
(760) 770-4166
Mailing address
44650 VILLAGE CT STE 100, PALM DESERT, CA 92260-3812
(760) 346-4003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A51307
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A51307
LICENSE
CA
Enumeration date
02/27/2009
Last updated
02/27/2009
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