Organization
CLINICAS DEL VALLE A PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULIN VEGA (CFO)
(760) 890-0190
Entity
Organization
Contact information
Practice address
120 W COLE BLVD STE B, CALEXICO, CA 92231-9700
(760) 890-0190
(760) 890-0160
Mailing address
120 W COLE BLVD STE B, CALEXICO, CA 92231-9700
(760) 890-0190
(760) 890-0160
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2084N0400X
Neurology Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10939837
CAQH
CA
01
—
1912512567
NPI
CA
Enumeration date
06/15/2021
Last updated
10/05/2021
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