Healthcare Provider Details

I. General information

NPI: 1750726485
Provider Name (Legal Business Name): DONALD L HAMBY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69780 STELLAR DR STE A
RANCHO MIRAGE CA
92270-2954
US

IV. Provider business mailing address

25745 BARTON RD # 301
LOMA LINDA CA
92354-3812
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-3380
  • Fax: 760-424-3375
Mailing address:
  • Phone: 901-493-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A14027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: