Provider Demographics
NPI:1043321185
Name:HIGH DESERT CARDIO-PULMONARY MEDICAL GROUP INC
Entity type:Organization
Organization Name:HIGH DESERT CARDIO-PULMONARY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERS
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJEEV/KAMLESH
Authorized Official - Middle Name:
Authorized Official - Last Name:YELAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-2221
Mailing Address - Street 1:16017 TUSCOLA RD STE A
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1317
Mailing Address - Country:US
Mailing Address - Phone:760-242-2221
Mailing Address - Fax:760-242-1249
Practice Address - Street 1:16017 TUSCOLA RD STE A
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1317
Practice Address - Country:US
Practice Address - Phone:760-242-2221
Practice Address - Fax:760-242-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14178ZMedicare PIN