Healthcare Provider Details

I. General information

NPI: 1194777235
Provider Name (Legal Business Name): DUSTIN COYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36485 INLAND VALLEY DR
WILDOMAR CA
92595-9681
US

IV. Provider business mailing address

1487 EAGLE GLN
ESCONDIDO CA
92029-3139
US

V. Phone/Fax

Practice location:
  • Phone: 951-677-1111
  • Fax:
Mailing address:
  • Phone: 801-598-1779
  • Fax: 801-701-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC168357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: