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Organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
Active
Organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VACHASPATHI PALAKODETI MD (PRESIDENT)
(760) 355-8300
Entity
Organization
Contact information
Practice address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
(760) 355-7730
(760) 355-7731
Mailing address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
(760) 355-7730
(760) 355-7731
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC6635
RAILROAD GROUP #
CA
05
—
GR0066310
—
CA
05
—
GR0066312
—
CA
05
—
GR0066313
—
CA
05
—
GR0066314
—
CA
05
—
GR0066315
—
CA
05
—
GR0066316
—
CA
05
—
GR0066318
—
CA
Enumeration date
05/05/2006
Last updated
10/29/2007
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