=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790785467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID STEPHEN WILGARDE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 06/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3001 E TAHQUITZ CANYON WAY STE 108
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92262-6900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-320-4292
-----------------------------------------------------
Fax | 760-322-9475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 W CAMINO ENCANTO
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92264-8910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-969-5200
-----------------------------------------------------
Fax | 760-969-5201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number | G744630
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | G74463
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------