Provider Demographics
NPI:1902817810
Name:GUNBERG, STEVEN R (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:GUNBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74785 US HIGHWAY 111
Mailing Address - Street 2:STE 101
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-7129
Mailing Address - Country:US
Mailing Address - Phone:760-836-3835
Mailing Address - Fax:760-501-0311
Practice Address - Street 1:81800 DR CARREON BLVD STE C
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5595
Practice Address - Country:US
Practice Address - Phone:760-836-3835
Practice Address - Fax:760-501-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A132662085R0202X
CO370572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
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