| Desert View Medical | |
|
205 N 1st St Ste A Blythe CA 92225-1777 | |
| (760) 921-3474 | |
| (760) 921-3471 |
| Full Name | Desert View Medical |
|---|---|
| Speciality | Family Medicine |
| Location | 205 N 1st St Ste A, Blythe, California |
| Authorized Official Name and Position | Kenneth G. Lucero (PRESIDENT) |
| Authorized Official Contact | 7609213468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert View Medical 205 N 1st St Ste A Blythe CA 92225-1777 Ph: (760) 921-3474 | Desert View Medical 205 N 1st St Ste A Blythe CA 92225-1777 Ph: (760) 921-3474 |
| NPI Number | 1023394285 |
|---|---|
| Provider Enumeration Date | 11/01/2011 |
| Last Update Date | 08/05/2013 |
| Medicare PECOS PAC ID | 4880847573 |
|---|---|
| Medicare Enrollment ID | O20130108000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023394285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G60508 (California) | Primary |
| Provider Name | Kenneth G Lucero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417079989 PECOS PAC ID: 7113947060 Enrollment ID: I20070605000594 |
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