Healthcare Provider Details

I. General information

NPI: 1710325683
Provider Name (Legal Business Name): COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81767 DR CARREON BLVD SUITE 201
INDIO CA
92201-5597
US

IV. Provider business mailing address

81767 DR CARREON BLVD 201
INDIO CA
92201-5597
US

V. Phone/Fax

Practice location:
  • Phone: 760-391-5151
  • Fax: 760-391-5159
Mailing address:
  • Phone: 760-775-4181
  • Fax: 760-775-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA64634
License Number StateCA

VIII. Authorized Official

Name: ARCE LOPEZ
Title or Position: MEDICAL BILLING COORDINATOR
Credential:
Phone: 760-863-1592