MEDICARE: PALM DESERT PEDIATRICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A740580	CA

General Provider Information

NPI Number	:	1558371484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM DESERT PEDIATRICS INC

Provider Business Mailing Address
First Line	:	73950 ALESSANDRO DR STE 5
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3637
Country	:	US
Telephone Number	:	760-341-9906
Fax Number	:	760-341-9916

Provider Business Practice Location Address
First Line	:	73950 ALESSANDRO DR STE 5
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3637
Country	:	US
Telephone Number	:	760-341-9906
Fax Number	:	760-341-9916

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ESTELLA GONZALES
Credential	:
Telephone Number	:	760-341-9906

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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Directions to “PALM DESERT PEDIATRICS INC ” Practice Location

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