# 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:** 1750112587
- **Legal business name:** IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
- **Authorized official:** VACHASPATHI PALAKODETI MD (AUTHORIZED REPRESENTATIVE)
- **Authorized official phone:** (760) 355-8300

## Contact information

- **Practice address:** 516 WEST ATEN ROAD, SUITE 1, IMPERIAL, CA 92251-9805
- **Practice address phone:** (760) 355-8300
- **Practice address fax:** (760) 545-0240
- **Mailing address:** 516 WEST ATEN ROAD, 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 |
| --- | --- | --- | --- | --- |
| 163WC3500X | Cardiac Rehabilitation Registered Nurse | — | NULL | Yes |
| 163WC3500X | Cardiac Rehabilitation Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 08/13/2024
- **Last updated:** 10/15/2024