Healthcare Provider Details

I. General information

NPI: 1598139883
Provider Name (Legal Business Name): VALLEY PEDIATRIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 08/29/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 W. PICO AVE SUITE 1
EL CENTRO CA
92243
US

IV. Provider business mailing address

1600 S IMPERIAL AVE 10
EL CENTRO CA
92243-4242
US

V. Phone/Fax

Practice location:
  • Phone: 760-970-4862
  • Fax: 760-970-4373
Mailing address:
  • Phone: 760-970-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA123164
License Number StateCA

VIII. Authorized Official

Name: AMEEN ALSHAREEF
Title or Position: MD
Credential: MD
Phone: 714-767-5659