Healthcare Provider Details

I. General information

NPI: 1083667646
Provider Name (Legal Business Name): QUIMBO GULAY CHING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81833 DR CARREON BLVD STE 6
INDIO CA
92201-5590
US

IV. Provider business mailing address

81833 DR CARREON BLVD STE 6
INDIO CA
92201-5590
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-7763
  • Fax: 760-775-9953
Mailing address:
  • Phone: 760-775-7763
  • Fax: 760-775-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-068065
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC134912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: