Healthcare Provider Details

I. General information

NPI: 1811319890
Provider Name (Legal Business Name): COACHELLA VALLEY CARE MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81767 DR CARREON BLVD STE 201
INDIO CA
92201-5599
US

IV. Provider business mailing address

81767 DR CARREON BLVD STE 201
INDIO CA
92201-5599
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-4181
  • Fax: 866-544-2050
Mailing address:
  • Phone: 760-775-4181
  • Fax: 866-544-2050

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: SAM Y LIN
Title or Position: OWNER
Credential: MD
Phone: 760-534-2707