Healthcare Provider Details

I. General information

NPI: 1356524599
Provider Name (Legal Business Name): MERVAT KELADA M D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLAIR AVE
CALEXICO CA
92231-2308
US

IV. Provider business mailing address

1001 BLAIR AVE
CALEXICO CA
92231-2308
US

V. Phone/Fax

Practice location:
  • Phone: 760-562-6633
  • Fax: 760-768-5037
Mailing address:
  • Phone: 760-562-6633
  • Fax: 760-768-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERVAT G. KELADA
Title or Position: PRESIDENT
Credential:
Phone: 760-768-5055