Healthcare Provider Details

I. General information

NPI: 1366408940
Provider Name (Legal Business Name): MARC DAVID DOBSON P A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47110 WASHINGTON ST STE 203
LA QUINTA CA
92253-2186
US

IV. Provider business mailing address

47110 WASHINGTON ST STE 203
LA QUINTA CA
92253-2186
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-9205
  • Fax: 760-771-6243
Mailing address:
  • Phone: 760-564-9205
  • Fax: 760-771-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1053227
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: