Basic Information
| Provider Information | |||||||||
| NPI: | 1902817810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUNBERG | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74785 US HIGHWAY 111 | ||||||||
| Address2: | STE 101 | ||||||||
| City: | INDIAN WELLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922107129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608363835 | ||||||||
| FaxNumber: | 7605010311 | ||||||||
| Practice Location | |||||||||
| Address1: | 81800 DR CARREON BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922015595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608363835 | ||||||||
| FaxNumber: | 7605010311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 20A13266 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.