Organization
PAIN AND SPINE CENTER OF THE DESERT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK HENRY CORONEL BOUFFARD IV M.D. (PRESIDENT)
(760) 776-7999
Entity
Organization
Contact information
Practice address
73271 FRED WARING DR, SUITE 102, PALM DESERT, CA 92260-2883
(760) 776-7999
(760) 776-7994
Mailing address
PO BOX 6720, LA QUINTA, CA 92248-6720
(760) 776-7999
(760) 776-7994
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
12/02/2011
Last updated
07/09/2014
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