Mirage Center Outpatient Surgery
Oral & Maxillofacial Surgery in Rancho Mirage, CA. Organization (NPI-2).
NPI number1245128917
StatusActive
Last updated in NPPESJun 24, 2025
Details
- NPI
- 1245128917
- Entity type
- Organization (NPI-2)
- Legal business name
- Mirage Center Outpatient Surgery
- Organization subpart
- No
- Enumeration date
- Jun 24, 2025
- Certification date
- Jun 24, 2025
- Last updated
- Jun 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 204E00000X | Oral & Maxillofacial Surgery | – | – | Yes |
Practice location
39935 Vista Del Sol Ste 101Rancho Mirage, CA 92270-3211
Phone 760-413-8182
Mailing address
39935 Vista Del Sol Ste 206Rancho Mirage, CA 92270-3211
Phone 760-413-8182
Authorized official
Justyn Mawby
Admin/Or Supervisor
7604859636
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