Healthcare Provider Details

I. General information

NPI: 1578507216
Provider Name (Legal Business Name): DAVID ELLSWORTH HJERPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45280 SEELEY DR 1ST FLR / URGENT CARE
LA QUINTA CA
92253-6834
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR BLDG B- 203
RANCHO MIRAGE CA
92270-4126
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-7210
  • Fax: 760-564-0101
Mailing address:
  • Phone: 760-674-3847
  • Fax: 760-674-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG 80101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: