Organization
LIFE CONNECT MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PADMA KHANCHUSTAMBAHM M.D (OWNER)
(760) 464-2166
Entity
Organization
Contact information
Practice address
35900 BOB HOPE DR, SUITE # 100, RANCHO MIRAGE, CA 92270-1766
(760) 699-7117
(760) 699-7750
Mailing address
36101 BOB HOPE DR, STE. E-5 #117, RANCHO MIRAGE, CA 92270-2001
(760) 217-0126
(760) 699-7750
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A86478
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AV186
MEDICARE PTAN
CA
Enumeration date
09/12/2008
Last updated
05/03/2016
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