Healthcare Provider Details

I. General information

NPI: 1396710646
Provider Name (Legal Business Name): PETER M KADILE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78100 MAIN ST STE 207
LA QUINTA CA
92253-8962
US

IV. Provider business mailing address

78100 MAIN ST STE 207
LA QUINTA CA
92253-8962
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7439
  • Fax: 760-777-1254
Mailing address:
  • Phone: 760-777-7439
  • Fax: 760-777-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: