Organization
JERALYN BROSSFIELD M.D., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERALYN BROSSFIELD MD (MEDICAL DIRECTOR)
(769) 691-2069
Entity
Organization
Contact information
Practice address
72301 COUNTRY CLUB DR STE 105, RANCHO MIRAGE, CA 92270-8007
(760) 567-8207
Mailing address
72301 COUNTRY CLUB DR STE 105, RANCHO MIRAGE, CA 92270-8007
(760) 567-8207
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10943589
CAQH
CA
01
—
AO64527
CA LICENSE NUMBER
CA
Enumeration date
01/29/2025
Last updated
01/29/2025
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