Healthcare Provider Details

I. General information

NPI: 1578011599
Provider Name (Legal Business Name): DAVID S WILGARDE M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 06/02/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E TAHQUITZ CANYON WAY STE 108
PALM SPRINGS CA
92262-6900
US

IV. Provider business mailing address

51753 EL DORADO DR
LA QUINTA CA
92253-9034
US

V. Phone/Fax

Practice location:
  • Phone: 760-320-4292
  • Fax: 760-322-9475
Mailing address:
  • Phone: 760-619-2309
  • Fax: 866-428-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG74463
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG74463
License Number StateCA

VIII. Authorized Official

Name: DAVID S WILGARDE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-619-2309