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General NPI Number Information
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NPI Number | 1417060518
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Entity Type | Organization
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Legal Business Name | IMPERIAL VALLEY WOMENS CLINIC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 495 E ORANGE AVE
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City | EL CENTRO
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State | CA
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Zip | 92243
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Country | US
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Telephone | 760-353-3331
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Fax | 760-353-5085
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Provider Business Mailing Address
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Address Line | 495 E ORANGE AVE
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City | EL CENTRO
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State | CA
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Zip | 92243
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Country | US
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Telephone | 760-353-3331
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Fax | 760-353-5085
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN E GOCKE
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Credential | MD
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Telephone | 760-353-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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