Healthcare Provider Details

I. General information

NPI: 1558910745
Provider Name (Legal Business Name): UNIQUE PEDIATRIC MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73733 FRED WARING DR STE 204
PALM DESERT CA
92260-2591
US

IV. Provider business mailing address

73733 FRED WARING DR STE 204
PALM DESERT CA
92260-2591
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-5620
  • Fax: 760-776-5626
Mailing address:
  • Phone: 760-776-5620
  • Fax: 760-776-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNESTO REYES MILLAN
Title or Position: CEO
Credential: MD
Phone: 760-776-5620