Organization
W.RAY HENDERSON MD INC
Active
Other names
RENAISSANCE COSMETIC SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
RAY HENDERSON M.D. (MEDICAL DIRECTOR)
(760) 346-3810
Entity
Organization
Contact information
Practice address
73180 EL PASEO, PALM DESERT, CA 92260-4218
(760) 346-3810
(760) 346-3083
Mailing address
73180 EL PASEO, PALM DESERT, CA 92260-4218
(760) 346-3810
(760) 346-3083
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
C24144
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250030001824
ASC PROVIDER NUMBER
CA
Enumeration date
06/06/2007
Last updated
11/28/2011
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