Organization
HI-DESERT MEDICAL CENTER
Active
Other names
Hi Desert Radiology Physician
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS DUDA (CFO)
(760) 366-6421
Entity
Organization
Contact information
Practice address
6601 WHITE FEATHER RD, JOSHUA TREE, CA 92252-6607
(760) 366-6355
(760) 366-6364
Mailing address
43500 RIDGE PARK DR, #102, TEMECULA, CA 92590-3624
(951) 699-0303
(951) 699-0603
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
240000231
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FNP31524
MEDICAL BOARD FICTITIOUS
CA
05
—
GR0095320
—
CA
01
—
ZZZ35026Z
BLUE SHIELD
CA
Enumeration date
03/06/2007
Last updated
06/25/2008
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