Healthcare Provider Details

I. General information

NPI: 1972784049
Provider Name (Legal Business Name): LOUIS STABILE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE 201
PALM SPRINGS CA
92262-4857
US

IV. Provider business mailing address

PO BOX 744
RANCHO MIRAGE CA
92270-0744
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 TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberG84437
License Number StateCA

VIII. Authorized Official

Name: LOUIS A STABILE
Title or Position: PRESIDENT
Credential: MD
Phone: 760-416-4511