Healthcare Provider Details

I. General information

NPI: 1669452371
Provider Name (Legal Business Name): ANNAMARIA T CHURCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82934 CIVIC CENTER DR
INDIO CA
92201-4308
US

IV. Provider business mailing address

82934 CIVIC CENTER DR
INDIO CA
92201-4308
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG162055
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301044151
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44006
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: