IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC NPI 1508295502

NPI Information

IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC is a rural health clinic center in Brawley, CA. IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC NPI is 1508295502. The provider is registered as an organization entity type.

The provider's business location address is:

608 G ST
SUITE 1A
BRAWLEY, CA
ZIP 92227-568
Phone: (760) 351-1011
Fax: (760) 545-0247

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 05D2125367 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/11/2013 and was last updated on 11/20/2013.

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:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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