Healthcare Provider Details

I. General information

NPI: 1477080992
Provider Name (Legal Business Name): MARK LOUIS GAERTNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S PALM CANYON DR
PALM SPRINGS CA
92262-7303
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-4560
  • Fax: 760-773-4561
Mailing address:
  • Phone: 760-773-4560
  • Fax: 760-773-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA163132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: