Provider Demographics
NPI:1255365748
Name:CUNNINGHAM, JOE DEE (HAD)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:DEE
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 S PALM CANYON DR
Mailing Address - Street 2:STE A
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7332
Mailing Address - Country:US
Mailing Address - Phone:760-325-3240
Mailing Address - Fax:760-325-4180
Practice Address - Street 1:353 S PALM CANYON DR STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7332
Practice Address - Country:US
Practice Address - Phone:760-325-3240
Practice Address - Fax:760-325-4180
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0028560Medicaid