Organization
FOUNTAIN VALLEY GROUP SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LARSEN (VP, CREDENTIALING)
(770) 874-5400
Entity
Organization
Contact information
Practice address
47111 MONROE ST, INDIO, CA 92201-6739
(760) 347-6191
Mailing address
5665 NEW NORTHSIDE DR, SUITE 320, ATLANTA, GA 30328-5831
(770) 874-5400
(770) 874-5483
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Enumeration date
10/01/2014
Last updated
10/25/2024
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