Provider Demographics
NPI:1285681882
Name:GAULTIER, CYRIL RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:RAYMOND
Last Name:GAULTIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-834-7930
Mailing Address - Fax:760-834-7931
Practice Address - Street 1:4791 E PALM CANYON DR STE 100
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-5232
Practice Address - Country:US
Practice Address - Phone:760-834-7930
Practice Address - Fax:760-834-7931
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 069794207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG69794FMedicare ID - Type Unspecified
CAF11457Medicare UPIN