# IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1508295502
- **Legal business name:** IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
- **Authorized official:** VACHASPATHI PALAKODETI M.D. (PRESIDENT)
- **Authorized official phone:** (760) 355-7730

## Contact information

- **Practice address:** 608 G ST, SUITE 1A, BRAWLEY, CA 92227-2568
- **Practice address phone:** (760) 351-1011
- **Practice address fax:** (760) 545-0247
- **Mailing address:** 516 W ATEN RD, SUITE 2, IMPERIAL, CA 92251-9805
- **Mailing address phone:** (760) 355-7730
- **Mailing address fax:** (760) 355-7731

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | CA | Yes |

## Other

- **Enumeration date:** 11/11/2013
- **Last updated:** 11/20/2013