Healthcare Provider Details

I. General information

NPI: 1992094924
Provider Name (Legal Business Name): JAMES C. PINE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76624 PANSY CIR
PALM DESERT CA
92211-7454
US

IV. Provider business mailing address

76624 PANSY CIR
PALM DESERT CA
92211-7454
US

V. Phone/Fax

Practice location:
  • Phone: 760-360-4888
  • Fax: 760-200-4321
Mailing address:
  • Phone: 760-360-4888
  • Fax: 760-200-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC25244
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberC25244
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES CHARLES PINE
Title or Position: OWNER
Credential: MD
Phone: 760-360-4888