1861630469 NPI number — LES J GURWITT MD A MEDICAL CORPORATION

Table of content: DR. JAMIE MATTHEW KUNKLE ND (NPI 1790023257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861630469 NPI number — LES J GURWITT MD A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LES J GURWITT MD A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861630469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39000 BOB HOPE DR
Provider Second Line Business Mailing Address:
K-406
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-3221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-346-3490
Provider Business Mailing Address Fax Number:
760-346-0675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39000 BOB HOPE DR
Provider Second Line Business Practice Location Address:
K-406
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-346-3490
Provider Business Practice Location Address Fax Number:
760-346-0675
Provider Enumeration Date:
02/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GURWITT
Authorized Official First Name:
LES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-346-3490

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G14998 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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