Healthcare Provider Details

I. General information

NPI: 1275721888
Provider Name (Legal Business Name): GARY M. ANNUNZIATA, D.O., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35900 BOB HOPE DR STE 275
RANCHO MIRAGE CA
92270-1766
US

IV. Provider business mailing address

35900 BOB HOPE DR STE 275
RANCHO MIRAGE CA
92270-1766
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-2500
  • Fax: 760-321-5720
Mailing address:
  • Phone: 760-321-2500
  • Fax: 760-321-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number020A66500
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number020A66500
License Number StateCA

VIII. Authorized Official

Name: DR. GARY M ANNUNZIATA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 760-321-2500