Provider Demographics
NPI:1013569037
Name:IMPERIAL COUNTY PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:IMPERIAL COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-265-1337
Mailing Address - Street 1:935 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2349
Mailing Address - Country:US
Mailing Address - Phone:442-265-1444
Mailing Address - Fax:760-352-9933
Practice Address - Street 1:935 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2349
Practice Address - Country:US
Practice Address - Phone:442-265-1444
Practice Address - Fax:760-352-9933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF IMPERIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local