Organization
CENTRAL DESERT INDUSTRIAL MEDICAL GROUP A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GWENDOLYN GROVE (EXECUTIVE OPERATIONS DIRECTOR)
(760) 242-7003
Entity
Organization
Contact information
Practice address
18031 US HIGHWAY 18, SUITE F, APPLE VALLEY, CA 92307-2152
(760) 242-7003
(730) 242-7703
Mailing address
18031 US HIGHWAY 18, SUITE F, APPLE VALLEY, CA 92307-2152
(760) 242-7003
(730) 242-7703
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
12656PA
CA
261QX0100X
Occupational Medicine Clinic/Center
Primary
20A5179
CA
Other
Enumeration date
10/29/2009
Last updated
08/31/2012
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