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General NPI Number Information
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NPI Number | 1932861176
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Entity Type | Organization
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Legal Business Name | COACHELLAMED A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR STE 100
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4150
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Country | US
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Telephone | 760-413-5027
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Fax |
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Provider Business Mailing Address
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Address Line | 72780 COUNTRY CLUB DR STE 100
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4150
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Country | US
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Telephone | 760-413-5027
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLOS LOPEZ
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Credential | MD
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Telephone | 760-413-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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