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General NPI Number Information
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NPI Number | 1265623524
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Entity Type | Organization
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Legal Business Name | IMPERIAL VALLEY ENDOCRINE MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 528 G ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2411
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Country | US
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Telephone | 760-344-6355
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Fax | 760-344-6921
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Provider Business Mailing Address
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Address Line | 528 G ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2411
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Country | US
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Telephone | 760-344-6355
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Fax | 760-344-6321
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Authorized Official
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Title or Position | CEO
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Name | RAMONA A KRUTZIK
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Credential | MD
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Telephone | 760-344-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A70812
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License Number State | CA
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