Healthcare Provider Details

I. General information

NPI: 1902817810
Provider Name (Legal Business Name): STEVEN R GUNBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81800 DR CARREON BLVD STE C
INDIO CA
92201-5595
US

IV. Provider business mailing address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7129
US

V. Phone/Fax

Practice location:
  • Phone: 760-836-3835
  • Fax: 760-501-0311
Mailing address:
  • Phone: 760-836-3835
  • Fax: 760-501-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A13266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: