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Organization
COACHELLA VALLEY RETINA
Active
Organization
COACHELLA VALLEY RETINA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILLE HARRISON MD (PRESIDENT)
(760) 464-8244
Entity
Organization
Contact information
Practice address
72301 COUNTRY CLUB DR STE 108, RANCHO MIRAGE, CA 92270-8007
(760) 895-1993
(760) 862-1992
Mailing address
72-301 COUNTRY CLUB DRIVE , SUITE 108, RANCHO MIRAGE, CA 92270
(760) 895-1993
(760) 862-1992
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A64900
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A649000
—
CA
Enumeration date
09/09/2013
Last updated
10/18/2013
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