Healthcare Provider Details

I. General information

NPI: 1033054077
Provider Name (Legal Business Name): PALM VALLEY VIRTUAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74699 TECHNOLOGY DR APT 14305
PALM DESERT CA
92211-5834
US

IV. Provider business mailing address

7 EVES DR
MARLTON NJ
08053-3196
US

V. Phone/Fax

Practice location:
  • Phone: 561-283-3646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA BUTLER
Title or Position: LICENSING MANAGER
Credential:
Phone: 561-283-3646