NPIMap

Organization Active NPI

High Desert Primary Care

Doing business as High Desert Primary Care - Hesperia

  • Non-Pharmacy Dispensing Site
  • Hesperia, CA
National Provider Identifier
1750576344
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A48751 Issued in CA
Legal business name
HIGH DESERT PRIMARY CARE
Doing business as
High Desert Primary Care - Hesperia
Practice address
17095 Main St
Hesperia, CA 92345-6004
Phone
(760) 948-6606
NPI assigned
Sep 7, 2007
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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

Authorized official

Name
Danielle Green
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A48751 CA Primary

Addresses

Primary practice location

17095 Main St
Hesperia, CA 92345-6004

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • High Desert Primary Care - Hesperia Doing business as

National Provider Directory

National Provider Directory
Tax ID family
High Desert Primary Care5 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1750576344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17095 MAIN ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456004",
            "telephone_number": "760-948-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH DESERT PRIMARY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-09-07",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A48751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Desert Primary Care - Hesperia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; 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.