Provider Demographics
NPI:1275284853
Name:PROCTOR, DAVID LOREN (RDAT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LOREN
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:RDAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78685 ROCKWELL CIR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1977
Mailing Address - Country:US
Mailing Address - Phone:949-370-4047
Mailing Address - Fax:
Practice Address - Street 1:44359 PALM ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3116
Practice Address - Country:US
Practice Address - Phone:760-342-6616
Practice Address - Fax:760-347-8276
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1264660917101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)