Healthcare Provider Details

I. General information

NPI: 1952369399
Provider Name (Legal Business Name): JAMES DONOVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/19/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78560 HIGHWAY 111
LA QUINTA CA
92253-2067
US

IV. Provider business mailing address

78560 HIGHWAY 111
LA QUINTA CA
92253-2067
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-3887
  • Fax: 760-340-1940
Mailing address:
  • Phone: 760-564-3887
  • Fax: 760-340-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.10523R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG84806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: