Organization
IMPERIAL COUNTY LOCAL HEALTH AUTHORITY
Active
Other names
Community Health Plan of Imperial Valley
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SOUTHWORTH (CFO)
(760) 970-5034
Entity
Organization
Contact information
Practice address
512 W ATEN RD, IMPERIAL, CA 92251-9718
(760) 970-5034
Mailing address
512 W ATEN RD, IMPERIAL, CA 92251-9718
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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