Healthcare Provider Details

I. General information

NPI: 1225278120
Provider Name (Legal Business Name): HURLEY GASTROENTEROLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N. INDIAN CANYON DRIVE SUITE E318
PALM SPRINGS CA
92262-4809
US

IV. Provider business mailing address

1180 N. INDIAN CANYON DRIVE SUITE E318
PALM SPRINGS CA
92262-4809
US

V. Phone/Fax

Practice location:
  • Phone: 760-327-5300
  • Fax: 760-327-5307
Mailing address:
  • Phone: 760-327-5300
  • Fax: 760-327-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG88404
License Number StateCA

VIII. Authorized Official

Name: ARNOLD G RIDDLE
Title or Position: MEDICAL PRACTICE ADMINISTRATOR
Credential:
Phone: 760-327-5300