# W.RAY HENDERSON MD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RENAISSANCE COSMETIC SURGERY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821291923
- **Authorized official:** RAY HENDERSON M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (760) 346-3810

## Contact information

- **Practice address:** 73180 EL PASEO, PALM DESERT, CA 92260-4218
- **Practice address phone:** (760) 346-3810
- **Practice address fax:** (760) 346-3083
- **Mailing address:** 73180 EL PASEO, PALM DESERT, CA 92260-4218
- **Mailing address phone:** (760) 346-3810
- **Mailing address fax:** (760) 346-3083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | C24144 | CA | Yes |

## Other

- **Enumeration date:** 06/06/2007
- **Last updated:** 11/28/2011