Provider Demographics
NPI:1487651790
Name:GURWITT, LES J (MD)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:J
Last Name:GURWITT
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 1:72780 COUNTRY CLUB DRIVE, SUITE A-103
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-779-5511
Mailing Address - Fax:760-773-3320
Practice Address - Street 1:72780 COUNTRY CLUB DRIVE, SUITE A-103
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-779-5511
Practice Address - Fax:760-773-3320
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2012-09-20
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAG14998207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G149980Medicare UPIN
BH436Medicare PIN
CAA-39402Medicare UPIN