Provider Demographics
NPI:1053898593
Name:INDIO SURGERY CENTER
Entity type:Organization
Organization Name:INDIO SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-396-5733
Mailing Address - Street 1:46900 MONROE ST STE B201
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4828
Mailing Address - Country:US
Mailing Address - Phone:760-396-5733
Mailing Address - Fax:760-396-5723
Practice Address - Street 1:46900 MONROE ST STE B201
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4828
Practice Address - Country:US
Practice Address - Phone:760-396-5733
Practice Address - Fax:760-396-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000265207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty