Healthcare Provider Details

I. General information

NPI: 1639508450
Provider Name (Legal Business Name): COMMUNITYCARE IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 K ST
BRAWLEY CA
92227-2737
US

IV. Provider business mailing address

1166 K ST
BRAWLEY CA
92227-2737
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-9951
  • Fax: 760-344-5840
Mailing address:
  • Phone: 760-344-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: YVONNE BELL
Title or Position: CEO
Credential: MBA
Phone: 760-344-9951