Healthcare Provider Details

I. General information

NPI: 1811009012
Provider Name (Legal Business Name): NUEVA CLINICA CALIFORNIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 6TH ST
COACHELLA CA
92236-1712
US

IV. Provider business mailing address

1490 6TH ST
COACHELLA CA
92236-1712
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-7800
  • Fax:
Mailing address:
  • Phone: 760-398-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUDOLPHO J ALEGRIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-398-7800