Healthcare Provider Details

I. General information

NPI: 1720011935
Provider Name (Legal Business Name): GREGORY ALAN PECCHIA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45280 SEELEY DR 3RD FLOOR
LA QUINTA CA
92253-6834
US

IV. Provider business mailing address

45280 SEELEY DR 3RD FLOOR
LA QUINTA CA
92253-6834
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-7300
  • Fax: 760-610-7301
Mailing address:
  • Phone: 760-610-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number20A4928
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A4928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: