Healthcare Provider Details

I. General information

NPI: 1134758774
Provider Name (Legal Business Name): PAIGE DUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 205
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

72780 COUNTRY CLUB DR STE 205
RANCHO MIRAGE CA
92270-4150
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7900
  • Fax: 760-834-7901
Mailing address:
  • Phone: 760-834-7900
  • Fax: 760-834-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA183814
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA183814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: