| Organization Name: | IMPERIAL COUNTY PHYSICIANS MEDICAL GROUP |
| NPI Number: | 1154440527 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES ROACH (PRESIDENT) |
| Mailing Address: | 6760 Top Gun St Suite 100 San Diego |
| State: | CA US |
| Postal Code: | 921214152 |
| Phone Number: | 8588247000 |
| Fax Number: | 8588247010 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 06/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |