Provider Demographics
NPI:1164506358
Name:VALLEY COMPREHENSIVE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:VALLEY COMPREHENSIVE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-342-8898
Mailing Address - Street 1:81-719 DR. CARREON BLVD
Mailing Address - Street 2:STE 2A
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5518
Mailing Address - Country:US
Mailing Address - Phone:760-342-8898
Mailing Address - Fax:760-342-9457
Practice Address - Street 1:81-719 DR. CARREON BLVD
Practice Address - Street 2:STE A
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-0707
Practice Address - Fax:760-347-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01117ZMedicare ID - Type Unspecified