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General NPI Number Information
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NPI Number | 1790921641
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Entity Type | Organization
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Legal Business Name | CLINICA MEDICA DEL VALLE, INC.
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Dates
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Enumeration Date | 12/24/2008
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Last Update Date | 12/24/2008
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Provider Practice Location Address
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Address Line | 52-565 HARRISON STREET SUITE 104
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City | COACHELLA
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State | CA
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Zip | 92236-1534
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Country | US
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Telephone | 760-398-0606
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Fax | 760-398-5507
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Provider Business Mailing Address
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Address Line | 52-565 HARRISON STREET SUITE 104
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City | COACHELLA
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State | CA
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Zip | 92236-1534
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Country | US
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Telephone | 760-398-0606
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Fax | 760-398-5507
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN M ACOSTA
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Credential | MD
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Telephone | 760-398-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | A66595
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License Number State | CA
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