| Organization Name: | IMPERIAL VALLEY MEDICAL CLINIC, INC |
| NPI Number: | 1730269622 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NORMA M. APODACA (EXUCUTIVE PROGRAM DIRECTOR) |
| Mailing Address: | 535 W. Cesar Chavez Blvd Calexico |
| State: | CA US |
| Postal Code: | 922312103 |
| Phone Number: | 7603576566 |
| Fax Number: | 7603570849 |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 13-02 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |