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General NPI Number Information
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NPI Number | 1356524599
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Entity Type | Organization
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Legal Business Name | MERVAT KELADA M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1001 BLAIR AVE
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City | CALEXICO
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State | CA
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Zip | 92231-2308
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Country | US
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Telephone | 760-562-6633
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Fax | 760-768-5037
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Provider Business Mailing Address
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Address Line | 1001 BLAIR AVE
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City | CALEXICO
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State | CA
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Zip | 92231-2308
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Country | US
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Telephone | 760-562-6633
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Fax | 760-768-5037
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Authorized Official
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Title or Position | PRESIDENT
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Name | MERVAT G. KELADA
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Credential |
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Telephone | 760-768-5055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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