# ICPMD

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

## Provider details

- **NPI number:** 1609763721
- **Authorized official:** MERVAT KELADA MD (CEO)
- **Authorized official phone:** (760) 562-6633

## Contact information

- **Practice address:** 207 E BARIONI BLVD STE A, IMPERIAL, CA 92251-1620
- **Practice address phone:** (760) 355-2999
- **Practice address fax:** (760) 768-5037
- **Mailing address:** 1001 BLAIR AVE, CALEXICO, CA 92231-2308
- **Mailing address phone:** (760) 562-6633
- **Mailing address fax:** (760) 768-5037

## Taxonomy

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

## Other

- **Enumeration date:** 06/20/2025
- **Last updated:** 07/17/2025