MEDICARE: IMPERIAL COUNTY PHYSICIANS MEDICAL GROUP CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1013516624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL COUNTY PHYSICIANS MEDICAL GROUP CLINIC

Provider Business Mailing Address
First Line	:	1503 N IMPERIAL AVE STE 105A
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6302
Country	:	US
Telephone Number	:	760-290-4297
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 N IMPERIAL AVE STE 105A
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6302
Country	:	US
Telephone Number	:	760-290-4297
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAJID MANI
Credential	:	MD
Telephone Number	:	760-352-7755

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	02/18/2025

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