Mirage Medical Group Center

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MIRAGE MEDICAL GROUP CENTER

Practice address

44650 Village CT Ste 100
Palm Desert, CA 92260-3812

Phone

(760) 346-4003

Fax

(760) 346-4443

NPI assigned

Nov 26, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Zoran Rubakovich

Title

Administrator

Phone

(760) 346-4003

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543190400000",
    "number": "1356811061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44650 VILLAGE CT STE 100",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922603812",
            "telephone_number": "760-346-4003",
            "fax_number": "760-346-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44650 VILLAGE CT STE 100",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922603812",
            "telephone_number": "760-346-4003",
            "fax_number": "760-346-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRAGE MEDICAL GROUP CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A",
        "authorized_official_last_name": "RUBAKOVICH",
        "authorized_official_first_name": "ZORAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "760-346-4003"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mind by Design Wellness Center, Inc
• Mark Morton Minot, MD, PH.D, MBA, MSEE
• Heather H Minshall, LMFT 51143
• Miracle Ranch
• Mirage Medical Group
• Ivana Miranda
• Matthew Donald Misuraca, MA, LMFT
• Cindy Miyamoto, MS., LMFT
• Keeley Ruth Mizell
• MKB Consulting LLC

• General Practice Physician in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.