W.Ray Henderson MD Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

C24144 Issued in CA

Legal business name

W.RAY HENDERSON MD INC

Practice address

73180 El Paseo
Palm Desert, CA 92260-4218

Phone

(760) 346-3810

Fax

(760) 346-3083

NPI assigned

Jun 6, 2007

Organization subpart

No

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

Authorized official

Name

Ray Henderson, M.D.

Title

Medical Director

Phone

(760) 346-3810

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• RENAISSANCE COSMETIC SURGERY Other name

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1821291923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73180 EL PASEO",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922604218",
            "telephone_number": "760-346-3810",
            "fax_number": "760-346-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73180 EL PASEO",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922604218",
            "telephone_number": "760-346-3810",
            "fax_number": "760-346-3083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.RAY HENDERSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "760-346-3810",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "C24144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASC PROVIDER  NUMBER",
            "identifier": "250030001824",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RENAISSANCE COSMETIC SURGERY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jenna Von Haden
• Ivy H Vu
• Vincent Hieu Vutran, DPT
• W Ray Henderson MD Inc
• W. Ray Henderson,MD Inc
• Donald H Wade, MD
• Sparkle Wafer
• Brent Wagner, M.D.
• Kara Ludmilla Wahlin, M.A.
• Wal-Mart Stores, Inc. (Wal-Mart Pharmacy 10-5096)

• Ambulatory Surgical Clinic/Center in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; 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.