Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A52805 | CA |
N | 208D00000X | General Practice Physician | A52805 | CA |
NPI | 1003841917 |
---|---|
Provider Name | Dr. Vivien Pacold |
First Address | Cathedral City, CA 92234-3387 |
Second Address | Cathedral City, CA 92234-3387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 05/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A5280501 | (05) | CA |