Healthcare Provider Details

I. General information

NPI: 1659079879
Provider Name (Legal Business Name): COVA LYNN MCNALLY CATC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 S 4TH ST
EL CENTRO CA
92243-6012
US

IV. Provider business mailing address

2695 S 4TH ST
EL CENTRO CA
92243-6012
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-2100
  • Fax:
Mailing address:
  • Phone: 760-482-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number23639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: