Provider Demographics
NPI:1558371484
Name:PALM DESERT PEDIATRICS INC
Entity Type:Organization
Organization Name:PALM DESERT PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-341-9906
Mailing Address - Street 1:73950 ALESSANDRO DR STE 5
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3637
Mailing Address - Country:US
Mailing Address - Phone:760-341-9906
Mailing Address - Fax:760-341-9916
Practice Address - Street 1:73950 ALESSANDRO DR STE 5
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3637
Practice Address - Country:US
Practice Address - Phone:760-341-9906
Practice Address - Fax:760-341-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA740580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty