# IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275581894
- **Authorized official:** VACHASPATHI PALAKODETI MD (PRESIDENT)
- **Authorized official phone:** (760) 355-8300

## Contact information

- **Practice address:** 516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
- **Practice address phone:** (760) 355-7730
- **Practice address fax:** (760) 355-7731
- **Mailing address:** 516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
- **Mailing address phone:** (760) 355-7730
- **Mailing address fax:** (760) 355-7731

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 10/29/2007

## 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 |