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Organization
MERVAT KELADA M D A MEDICAL CORPORATION
Active
Organization
MERVAT KELADA M D A MEDICAL CORPORATION
Active
Parent organization
DE ANZA CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DE ANZA CLINIC
Authorized official
DR. MERVAT GAMIL KELADA M.D. (ADMINISTRATOR)
(760) 355-4150
Entity
Organization
Contact information
Practice address
207 E BARIONI BLVD, IMPERIAL, CA 92251-1619
(760) 355-2999
(760) 355-4150
Mailing address
207 E BARIONI BLVD, IMPERIAL, CA 92251-1619
(760) 355-2999
(760) 355-4150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A48353
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A483531
INSURANCE
CA
05
—
00A483532
—
CA
01
—
A48353
MD LICENSE #
CA
Enumeration date
02/15/2007
Last updated
06/21/2018
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