Organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
Active
Parent organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
Organization subpart
Yes
Provider details
NPI number
Legal business name
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
Authorized official
VACHASPATHI PALAKODETI M.D. (PRESIDENT)
(760) 355-7730
Entity
Organization
Contact information
Practice address
608 G ST, SUITE 1A, BRAWLEY, CA 92227-2568
(760) 351-1011
(760) 545-0247
Mailing address
516 W ATEN RD, SUITE 2, IMPERIAL, CA 92251-9805
(760) 355-7730
(760) 355-7731
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0066310
—
CA
05
—
GR0066318
—
CA
Enumeration date
11/11/2013
Last updated
11/20/2013
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