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NPI Code Detail

MEDICARE: EL CENTRO PHYSICIAN SERVICES, A MEDICAL CORPORATION

MEDICARE: EL CENTRO PHYSICIAN SERVICES, A MEDICAL CORPORATION
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
1207VX0201XGynecologic Oncology Physician
2207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1538701990
Entity Type Code : Organization
Provider Name (Legal Business Name) : EL CENTRO PHYSICIAN SERVICES, A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 1271 ROSS AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-4304
Country : US
Telephone Number : 760-791-4293
Fax Number :
Provider Business Practice Location Address
First Line : 1271 ROSS AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-4304
Country : US
Telephone Number : 760-791-4293
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CHARLES HUMPHREY
Credential : MD
Telephone Number : 760-791-4293
Provider Enumeration Date : 10/16/2019
Last Update Date : 10/16/2019

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