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IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP NPI 1376820159


NPI Information

NPI: 1376820159
Provider Name: IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP
Classification: General Practice - 208D00000X
Entity Type: Organization

CLIA Number: 05D2125040

Address:
1520 SOUTH IMPERIAL AVENUE
EL CENTRO, CA
ZIP 92243
Phone: (760) 592-4586
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IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP is a general practice in El Centro, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP NPI is 1376820159. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1520 SOUTH IMPERIAL AVENUE
EL CENTRO, CA
ZIP 92243
Phone: (760) 592-4586
Fax: (760) 545-0252

The provider's authorized official is Vachaspathi Palakodeti .
The authorized official title is President and has the following contact phone number (760) 355-7730.

The CLIA number assigned to this NPI record is 05D2125040 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/8/2011 and was last updated on 11/8/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208D00000XGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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