1710325683 NPI number — COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710325683 NPI number — COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC
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:
1710325683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81767 DR CARREON BLVD
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
INDIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92201-5597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-775-4181
Provider Business Mailing Address Fax Number:
760-775-4818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81767 DR CARREON BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201-5597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-391-5151
Provider Business Practice Location Address Fax Number:
760-391-5159
Provider Enumeration Date:
06/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ARCE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL BILLING COORDINATOR
Authorized Official Telephone Number:
760-863-1592

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A64634 , 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)





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