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General NPI Number Information
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NPI Number | 1184292179
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Entity Type | Organization
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Legal Business Name | CLINICAS DEL VALLE A PROFESSIONAL CORP
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 120 W COLE BLVD STE B
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City | CALEXICO
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State | CA
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Zip | 92231-9700
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Country | US
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Telephone | 760-890-0190
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Fax | 760-890-0160
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Provider Business Mailing Address
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Address Line | 120 W COLE BLVD STE B
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City | CALEXICO
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State | CA
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Zip | 92231-9700
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Country | US
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Telephone | 760-890-0190
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Fax | 760-890-0160
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Authorized Official
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Title or Position | CFO
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Name | PAULIN VEGA
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Credential |
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Telephone | 760-890-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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