Organization
LAS PALMAS MEDICAL GROUP
Active
Other names
Valley Immediate Care
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS MENA (OFFICE MANAGER)
(760) 480-4747
Entity
Organization
Contact information
Practice address
1540 E VALLEY PKWY, ESCONDIDO, CA 92027-2316
(760) 621-4902
(760) 400-0012
Mailing address
1540 E VALLEY PKWY, ESCONDIDO, CA 92027-2316
(760) 621-4902
(760) 400-0012
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G57022
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164503652
—
CA
05
—
1770663551
—
CA
Enumeration date
02/09/2011
Last updated
02/14/2011
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