MEDICARE: DR. VIVIEN PACOLD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A52805	CA
2	208D00000X	General Practice Physician	A52805	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003841917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIEN PACOLD M.D.

Provider Business Mailing Address
First Line	:	68100 RAMON RD
Second Line	:	C-5
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3387
Country	:	US
Telephone Number	:	760-321-6068
Fax Number	:	760-770-6789

Provider Business Practice Location Address
First Line	:	68100 RAMON RD
Second Line	:	C-5
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3387
Country	:	US
Telephone Number	:	760-321-6068
Fax Number	:	760-770-6789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/05/2012

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