Healthcare Provider Details

I. General information

NPI: 1619974409
Provider Name (Legal Business Name): MARK C FREITAG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-3911
  • Fax:
Mailing address:
  • Phone: 760-340-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA45860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: