Basic Information
| Provider Information | |||||||||
| NPI: | 1578011599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID S WILGARDE M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51753 EL DORADO DR | ||||||||
| Address2: | |||||||||
| City: | LA QUINTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922539034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606192309 | ||||||||
| FaxNumber: | 8664280708 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 E TAHQUITZ CANYON WAY STE 108 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922626900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603204292 | ||||||||
| FaxNumber: | 7603229475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2016 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILGARDE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7606192309 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | G74463 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208100000X | G74463 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.