1508295502 NPI number — IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC

Table of content: DR. JOEL HOWARD KAPLAN M.D. (NPI 1861518516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508295502 NPI number — IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508295502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 W ATEN RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92251-9805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-355-7730
Provider Business Mailing Address Fax Number:
760-355-7731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 G ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
BRAWLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92227-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-351-1011
Provider Business Practice Location Address Fax Number:
760-545-0247
Provider Enumeration Date:
11/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PALAKODETI
Authorized Official First Name:
VACHASPATHI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-355-7730

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0066310 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0066318 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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