Provider Demographics
NPI:1023161635
Name:HIGH DESERT OSTEOPATHIC MEDICAL CARE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:HIGH DESERT OSTEOPATHIC MEDICAL CARE A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-946-1776
Mailing Address - Street 1:16017 TUSCOLA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1317
Mailing Address - Country:US
Mailing Address - Phone:760-946-1776
Mailing Address - Fax:760-946-1668
Practice Address - Street 1:16017 TUSCOLA RD
Practice Address - Street 2:SUITE E
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1317
Practice Address - Country:US
Practice Address - Phone:760-946-1776
Practice Address - Fax:760-946-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty