Provider Demographics
NPI:1205988409
Name:VIVIEN PACOLD, M.D., INC.
Entity type:Organization
Organization Name:VIVIEN PACOLD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-321-6068
Mailing Address - Street 1:68100 RAMON RD
Mailing Address - Street 2:C-5
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3387
Mailing Address - Country:US
Mailing Address - Phone:760-321-6068
Mailing Address - Fax:760-770-6789
Practice Address - Street 1:68100 RAMON RD
Practice Address - Street 2:C-5
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3387
Practice Address - Country:US
Practice Address - Phone:760-321-6068
Practice Address - Fax:760-770-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A528050Medicare ID - Type Unspecified