Organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VACHASPATHI PALAKODETI MD (PRESIDENT)
(760) 355-8300
Entity
Organization
Contact information
Practice address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
(760) 355-7730
(760) 355-7731
Mailing address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
(760) 355-7730
(760) 355-7731
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC6635
RAILROAD GROUP #
CA
05
—
GR0066310
—
CA
05
—
GR0066312
—
CA
05
—
GR0066313
—
CA
05
—
GR0066314
—
CA
05
—
GR0066315
—
CA
05
—
GR0066316
—
CA
05
—
GR0066318
—
CA
Enumeration date
05/05/2006
Last updated
10/29/2007
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