Organization
FOUNTAIN VALLEY GROUP SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM H LARSEN (VP, CREDENTIALING)
(770) 874-5468
Entity
Organization
Contact information
Practice address
47111 MONROE ST, INDIO, CA 92201-6739
(760) 347-6191
Mailing address
5665 NEW NORTHSIDE DR STE 320, ATLANTA, GA 30328-5834
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
03/03/2026
Last updated
03/03/2026
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