Healthcare Provider Details

I. General information

NPI: 1003841917
Provider Name (Legal Business Name): VIVIEN PACOLD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68100 RAMON RD C-5
CATHEDRAL CITY CA
92234-3387
US

IV. Provider business mailing address

68100 RAMON RD C-5
CATHEDRAL CITY CA
92234-3387
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-6068
  • Fax: 760-770-6789
Mailing address:
  • Phone: 760-321-6068
  • Fax: 760-770-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52805
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA52805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: