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Organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
Active
Organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
Active
Parent organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
Organization subpart
Yes
Provider details
NPI number
Legal business name
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
Authorized official
VACHASPATHI PALAKODETI MD (AUTHORIZED REPRESENTATIVE)
(760) 355-8300
Entity
Organization
Contact information
Practice address
516 WEST ATEN ROAD, SUITE 1, IMPERIAL, CA 92251-9805
(760) 355-8300
(760) 545-0240
Mailing address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251-9805
(760) 355-7730
(760) 355-7731
Taxonomy
Speciality
Code
Description
License number
State
163WC3500X
Cardiac Rehabilitation Registered Nurse
Primary
—
NULL
163WC3500X
Cardiac Rehabilitation Registered Nurse
Primary
—
—
Other
Enumeration date
08/13/2024
Last updated
10/15/2024
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