Organization
CHUCKAWALA VALLWY STATE PRISON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LEE M.D. (CME)
(760) 922-5300
Entity
Organization
Contact information
Practice address
19025 WILEYS WELL RD, BLYTHE, CA 92225-2287
(760) 922-5300
Mailing address
19025 WILEYS WELL RD, BLYTHE, CA 92225-2287
(760) 922-5300
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
63848
CA
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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