Healthcare Provider Details

I. General information

NPI: 1760550701
Provider Name (Legal Business Name): DATE PALM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E HOBSONWAY
BLYTHE CA
92225-1739
US

IV. Provider business mailing address

604 E HOBSONWAY
BLYTHE CA
92225-1739
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-3644
  • Fax: 760-922-2671
Mailing address:
  • Phone: 760-922-3644
  • Fax: 760-922-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC22232
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC22232
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER T. SPELSBERG
Title or Position: OFFICER
Credential: M.D.
Phone: 760-922-3644