Healthcare Provider Details

I. General information

NPI: 1598840258
Provider Name (Legal Business Name): EL CENTRO REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E BIRCH ST STE A
CALEXICO CA
92231-2374
US

IV. Provider business mailing address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-0508
  • Fax:
Mailing address:
  • Phone: 760-339-7495
  • Fax: 760-339-7389

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: TISHA IRENE BENAVIDEZ
Title or Position: PATIENT FINANCIAL SERVICES DIRECTOR
Credential:
Phone: 760-482-5334