Healthcare Provider Details

I. General information

NPI: 1124291844
Provider Name (Legal Business Name): CANDICE NICOLE DUBOSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 11/08/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE W200
PALM SPRINGS CA
92262-4876
US

IV. Provider business mailing address

1180 N INDIAN CANYON DR STE W200
PALM SPRINGS CA
92262-4876
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4511
  • Fax: 760-416-4512
Mailing address:
  • Phone: 760-416-4511
  • Fax: 760-416-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME117189
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number33457
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number168477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: