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General NPI Number Information
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NPI Number | 1972893766
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Entity Type | Organization
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Legal Business Name | DANIEL J. FITZGERALD, III, M.D., PROF. CORP
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 74075 EL PASEO SUITE B-1
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City | PALM DESERT
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State | CA
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Zip | 92260-4118
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Country | US
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Telephone | 760-346-4600
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Fax | 760-346-6433
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Provider Business Mailing Address
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Address Line | 74075 EL PASEO SUITE B-1
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City | PALM DESERT
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State | CA
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Zip | 92260-4118
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Country | US
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Telephone | 760-346-4600
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Fax | 760-346-6433
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LINDA VIRGINIA KEMMER
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Credential |
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Telephone | 760-346-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | G87039
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G87039
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License Number State | CA
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